Lift Station Inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Time on site

  Date

Visual Inspection

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

  Yes

  No

  N/A

• Is the lift station free of signs of overflow?

  Yes

  No

  N/A

Runtime

• Pump 1 runtime hours

  Yes

  No

  N/A

• Current power setting

  Hand

  Off

  Auto

• Pump 2 runtime hours

  Yes

  No

  N/A

• Current power setting

  Hand

  Off

  Auto

Amp readings

• Pump 1 amp reading.

  Yes

  No

  N/A

• Pump 2 amp reading.

  Yes

  No

  N/A

Wet well inspection

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A