• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Time on site

Visual Inspection

  • Is the perimeter of the lift station free of overgrowth or debris?

  • Is the lift station free of signs of overflow?


  • Pump 1 runtime hours

  • Current power setting

  • Pump 2 runtime hours

  • Current power setting

Amp readings

  • Pump 1 amp reading.

  • Pump 2 amp reading.

Wet well inspection

  • Is the wet well free of grease and/or rags?

  • Are the floats hanging free and clear of rags or grease?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.