Title Page
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Technical ID -
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Equipment Description -
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Work Order Number -
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Plant Location
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Inspection Conducted on
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Inspectors
1 - Inspection
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1.0 Overall Condition of the Asset
- Fit for Service
- Not Fit for Service
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Item 1.1 - Check signage shows correct information and is in an acceptable condition
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Item 1.2 - Condition of Equipment
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Item 1.3 - Condition of Equipment
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Item 1.4 - Condition of Equipment
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Item 1.5 - Condition of Equipment
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Item 1.6 - Condition of Equipment
Section: 2 - Emergent Work
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Work Order Number -
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Photos of what needed to be done
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Describe the emergent work performed
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Work Order Number -
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Photos of what needed to be done
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Describe the emergent work performed
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Work Order Number -
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Photos of what needed to be done
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Describe the emergent work performed
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Photos of what needed to be done
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Describe the emergent work performed
3 - Follow-up Work Required
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Attach Photo of Issue #1 from Inspection
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State the Issue #1
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Recommendation #1
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Attach Photo of Issue #2 from Inspection
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State the Issue #2
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Recommendation #2
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Attach Photo of Issue #3 from Inspection
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State the Issue #3
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Recommendation #3
4 - Sign Off
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Inspector Signature
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Inspector Name and Title
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Manager Name and Title
