Information

  • Customer Name

  • site name:

  • Customer Address
  • Motivair Job Number:

A. General Site / Survey Information

  • Select date

  • Survey completed by (Motivair Engineer):

  • Do you have details of the site contact?

Site Contact details

  • Site contact name:

  • Contact telephone No's:

  • Contact e-mail:

General Site Information

  • How many Plant Rooms on Site

  • Number of surveys carried out on this site:

  • This survey relates to Plant Room Name/Building/Room No :

  • Does Motivair currently maintain the equipment - (if No - add detail)<br>

  • Who currently maintains the compressed air

  • 5. Does the Customer have other sites - if "Yes" add detail below<br><br>

  • Details of other sites:

  • 6. Is the customer interested in saving money on Energy and Service Costs

Written Scheme of Examination

  • 7. Does the customer have a Written Scheme of Examination

What is the system working pressure (If more than 1 system on this survey then please detail this below):

  • System working pressure in Bar:

What is the estimated qty of fixed pipework (If more than 1 system on this survey then please detail this below):

  • Estimated qty of fixed pipework:

Additional Site Information

  • Is a site Induction required to carry out works on this site?

  • Induction time:

  • Are there any special Access areas, Additional passes required, Area restrictions, Key holders etc?

  • Please enter details of any additional information - Parking, Access, Permits, Keys, etc:

B. Compressor's

  • How many compressors on site?

Compressor 1 Information

  • Compressor Type

  • Other Equipment, please state:

  • Location: Building No/Building Name

  • Manufacturer:

  • Other Manufacturer:

  • Model No

  • Serial No

  • Customers Asset No:

  • Kw Rating

  • Running Hours

  • Picture of compressor data plate:

  • Pressure rating:

  • Other Pressure:

  • Drive Arrangement:

  • Belt Part Number:

  • Quantity of belts:

  • Capacity (CFM, l/m, l/h, m3/h, etc) Please state:

  • Year of Manufacture

  • Next Service Due

  • Are there any Faults with this Compressor

  • Details of faults:

  • What Oil is used in this Compressor

  • Other Oil, give details:

  • Media being compressed:

  • Is there anything more Specific to this Compressor

  • List the Specific Detail here:

  • Take Pictures of Compressor

Compressor 1 Information

  • Compressor Type

  • Other Equipment, please state:

  • Location: Building No/Building Name

  • Manufacturer:

  • Other Manufacturer:

  • Model No

  • Serial No

  • Customers Asset No:

  • Kw Rating

  • Running Hours

  • Picture of compressor data plate:

  • Pressure rating:

  • Other Pressure:

  • Drive Arrangement:

  • Belt Part Number:

  • Quantity of belts:

  • Capacity (CFM, l/m, l/h, m3/h, etc) Please state:

  • Year of Manufacture

  • Next Service Due

  • Are there any Faults with this Compressor

  • Details of faults:

  • What Oil is used in this Compressor

  • Other Oil, give details:

  • Media being compressed:

  • Is there anything more Specific to this Compressor

  • List the Specific Detail here:

  • Take Pictures of Compressor

Compressor 2 Information

  • Compressor Type

  • Other Equipment, please state:

  • Location: Building No/Building Name

  • Manufacturer:

  • Other Manufacturer:

  • Model No

  • Serial No

  • Customers Asset No:

  • Kw Rating

  • Running Hours

  • Picture of compressor data plate:

  • Pressure rating:

  • Other Pressure:

  • Drive Arrangement:

  • Belt Part Number:

  • Quantity of belts:

  • Capacity (CFM, l/m, l/h, m3/h, etc) Please state:

  • Year of Manufacture

  • Next Service Due

  • Are there any Faults with this Compressor

  • Details of faults:

  • What Oil is used in this Compressor

  • Other Oil, give details:

  • Media being compressed:

  • Is there anything more Specific to this Compressor

  • List the Specific Detail here:

  • Take Pictures of Compressor

Compressor 1 Information

  • Compressor Type

  • Other Equipment, please state:

  • Location: Building No/Building Name

  • Manufacturer:

  • Other Manufacturer:

  • Model No

  • Serial No

  • Customers Asset No:

  • Kw Rating

  • Running Hours

  • Picture of compressor data plate:

  • Pressure rating:

  • Other Pressure:

  • Drive Arrangement:

  • Belt Part Number:

  • Quantity of belts:

  • Capacity (CFM, l/m, l/h, m3/h, etc) Please state:

  • Year of Manufacture

  • Next Service Due

  • Are there any Faults with this Compressor

  • Details of faults:

  • What Oil is used in this Compressor

  • Other Oil, give details:

  • Media being compressed:

  • Is there anything more Specific to this Compressor

  • List the Specific Detail here:

  • Take Pictures of Compressor

Compressor 2 Information

  • Compressor Type

  • Other Equipment, please state:

  • Location: Building No/Building Name

  • Manufacturer:

  • Other Manufacturer:

  • Model No

  • Serial No

  • Customers Asset No:

  • Kw Rating

  • Running Hours

  • Picture of compressor data plate:

  • Pressure rating:

  • Other Pressure:

  • Drive Arrangement:

  • Belt Part Number:

  • Quantity of belts:

  • Capacity (CFM, l/m, l/h, m3/h, etc) Please state:

  • Year of Manufacture

  • Next Service Due

  • Are there any Faults with this Compressor

  • Details of faults:

  • What Oil is used in this Compressor

  • Other Oil, give details:

  • Media being compressed:

  • Is there anything more Specific to this Compressor

  • List the Specific Detail here:

  • Take Pictures of Compressor

Compressor 3 Information

  • Compressor Type

  • Other Equipment, please state:

  • Location: Building No/Building Name

  • Manufacturer:

  • Other Manufacturer:

  • Model No

  • Serial No

  • Customers Asset No:

  • Kw Rating

  • Running Hours

  • Picture of compressor data plate:

  • Pressure rating:

  • Other Pressure:

  • Drive Arrangement:

  • Belt Part Number:

  • Quantity of belts:

  • Capacity (CFM, l/m, l/h, m3/h, etc) Please state:

  • Year of Manufacture

  • Next Service Due

  • Are there any Faults with this Compressor

  • Details of faults:

  • What Oil is used in this Compressor

  • Other Oil, give details:

  • Media being compressed:

  • Is there anything more Specific to this Compressor

  • List the Specific Detail here:

  • Take Pictures of Compressor

Compressor 1 Information

  • Compressor Type

  • Other Equipment, please state:

  • Location: Building No/Building Name

  • Manufacturer:

  • Other Manufacturer:

  • Model No

  • Serial No

  • Customers Asset No:

  • Kw Rating

  • Running Hours

  • Picture of compressor data plate:

  • Pressure rating:

  • Other Pressure:

  • Drive Arrangement:

  • Belt Part Number:

  • Quantity of belts:

  • Capacity (CFM, l/m, l/h, m3/h, etc) Please state:

  • Year of Manufacture

  • Next Service Due

  • Are there any Faults with this Compressor

  • Details of faults:

  • What Oil is used in this Compressor

  • Other Oil, give details:

  • Media being compressed:

  • Is there anything more Specific to this Compressor

  • List the Specific Detail here:

  • Take Pictures of Compressor

Compressor 2 Information

  • Compressor Type

  • Other Equipment, please state:

  • Location: Building No/Building Name

  • Manufacturer:

  • Other Manufacturer:

  • Model No

  • Serial No

  • Customers Asset No:

  • Kw Rating

  • Running Hours

  • Picture of compressor data plate:

  • Pressure rating:

  • Other Pressure:

  • Drive Arrangement:

  • Belt Part Number:

  • Quantity of belts:

  • Capacity (CFM, l/m, l/h, m3/h, etc) Please state:

  • Year of Manufacture

  • Next Service Due

  • Are there any Faults with this Compressor

  • Details of faults:

  • What Oil is used in this Compressor

  • Other Oil, give details:

  • Media being compressed:

  • Is there anything more Specific to this Compressor

  • List the Specific Detail here:

  • Take Pictures of Compressor

Compressor 3 Information

  • Compressor Type

  • Other Equipment, please state:

  • Location: Building No/Building Name

  • Manufacturer:

  • Other Manufacturer:

  • Model No

  • Serial No

  • Customers Asset No:

  • Kw Rating

  • Running Hours

  • Picture of compressor data plate:

  • Pressure rating:

  • Other Pressure:

  • Drive Arrangement:

  • Belt Part Number:

  • Quantity of belts:

  • Capacity (CFM, l/m, l/h, m3/h, etc) Please state:

  • Year of Manufacture

  • Next Service Due

  • Are there any Faults with this Compressor

  • Details of faults:

  • What Oil is used in this Compressor

  • Other Oil, give details:

  • Media being compressed:

  • Is there anything more Specific to this Compressor

  • List the Specific Detail here:

  • Take Pictures of Compressor

Compressor 4 Information

  • Compressor Type

  • Other Equipment, please state:

  • Location: Building No/Building Name

  • Manufacturer:

  • Other Manufacturer:

  • Model No

  • Serial No

  • Customers Asset No:

  • Kw Rating

  • Running Hours

  • Picture of compressor data plate:

  • Pressure rating:

  • Other Pressure:

  • Drive Arrangement:

  • Belt Part Number:

  • Quantity of belts:

  • Capacity (CFM, l/m, l/h, m3/h, etc) Please state:

  • Year of Manufacture

  • Next Service Due

  • Are there any Faults with this Compressor

  • Details of faults:

  • What Oil is used in this Compressor

  • Other Oil, give details:

  • Media being compressed:

  • Is there anything more Specific to this Compressor

  • List the Specific Detail here:

  • Take Pictures of Compressor

For more than 5 carry out further surveys for additional compressors.

Compressor 1 Information

  • Compressor Type

  • Other Equipment, please state:

  • Location: Building No/Building Name

  • Manufacturer:

  • Other Manufacturer:

  • Model No

  • Serial No

  • Customers Asset No:

  • Kw Rating

  • Running Hours

  • Picture of compressor data plate:

  • Pressure rating:

  • Other Pressure:

  • Drive Arrangement:

  • Belt Part Number:

  • Quantity of belts:

  • Capacity (CFM, l/m, l/h, m3/h, etc) Please state:

  • Year of Manufacture

  • Next Service Due

  • Are there any Faults with this Compressor

  • Details of faults:

  • What Oil is used in this Compressor

  • Other Oil, give details:

  • Media being compressed:

  • Is there anything more Specific to this Compressor

  • List the Specific Detail here:

  • Take Pictures of Compressor

Compressor 2 Information

  • Compressor Type

  • Other Equipment, please state:

  • Location: Building No/Building Name

  • Manufacturer:

  • Other Manufacturer:

  • Model No

  • Serial No

  • Customers Asset No:

  • Kw Rating

  • Running Hours

  • Picture of compressor data plate:

  • Pressure rating:

  • Other Pressure:

  • Drive Arrangement:

  • Belt Part Number:

  • Quantity of belts:

  • Capacity (CFM, l/m, l/h, m3/h, etc) Please state:

  • Year of Manufacture

  • Next Service Due

  • Are there any Faults with this Compressor

  • Details of faults:

  • What Oil is used in this Compressor

  • Other Oil, give details:

  • Media being compressed:

  • Is there anything more Specific to this Compressor

  • List the Specific Detail here:

  • Take Pictures of Compressor

Compressor 3 Information

  • Compressor Type

  • Other Equipment, please state:

  • Location: Building No/Building Name

  • Manufacturer:

  • Other Manufacturer:

  • Model No

  • Serial No

  • Customers Asset No:

  • Kw Rating

  • Running Hours

  • Picture of compressor data plate:

  • Pressure rating:

  • Other Pressure:

  • Drive Arrangement:

  • Belt Part Number:

  • Quantity of belts:

  • Capacity (CFM, l/m, l/h, m3/h, etc) Please state:

  • Year of Manufacture

  • Next Service Due

  • Are there any Faults with this Compressor

  • Details of faults:

  • What Oil is used in this Compressor

  • Other Oil, give details:

  • Media being compressed:

  • Is there anything more Specific to this Compressor

  • List the Specific Detail here:

  • Take Pictures of Compressor

Compressor 4 Information

  • Compressor Type

  • Other Equipment, please state:

  • Location: Building No/Building Name

  • Manufacturer:

  • Other Manufacturer:

  • Model No

  • Serial No

  • Customers Asset No:

  • Kw Rating

  • Running Hours

  • Picture of compressor data plate:

  • Pressure rating:

  • Other Pressure:

  • Drive Arrangement:

  • Belt Part Number:

  • Quantity of belts:

  • Capacity (CFM, l/m, l/h, m3/h, etc) Please state:

  • Year of Manufacture

  • Next Service Due

  • Are there any Faults with this Compressor

  • Details of faults:

  • What Oil is used in this Compressor

  • Other Oil, give details:

  • Media being compressed:

  • Is there anything more Specific to this Compressor

  • List the Specific Detail here:

  • Take Pictures of Compressor

Compressor 5 Information

  • Compressor Type

  • Other Equipment, please state:

  • Location: Building No/Building Name

  • Manufacturer:

  • Other Manufacturer:

  • Model No

  • Serial No

  • Customers Asset No:

  • Kw Rating

  • Running Hours

  • Picture of compressor data plate:

  • Pressure rating:

  • Other Pressure:

  • Drive Arrangement:

  • Belt Part Number:

  • Quantity of belts:

  • Capacity (CFM, l/m, l/h, m3/h, etc) Please state:

  • Year of Manufacture

  • Next Service Due

  • Are there any Faults with this Compressor

  • Details of faults:

  • What Oil is used in this Compressor

  • Other Oil, give details:

  • Media being compressed:

  • Is there anything more Specific to this Compressor

  • List the Specific Detail here:

  • Take Picture of Compressor

C. Dryers

  • Does the customer have any dryers on site?

Continue to Receiver section.

  • How many Dryers on site?

Dryer 1 Information

  • Location: Building No/Name

  • Manufacturer:

  • Other Manufacturer

  • Model No

  • Serial No

  • Customers asset No:

  • Dryer Type:

  • What refrigerant gas is being used:

  • Quantity of refrigerant (kg):

  • Is the dryer integral to one of the compressors?:

  • INTEGRAL? Please give details:

  • Kw Rating

  • Capacity (CFM, l/min, m3/hr, etc)

  • Port Size (inches)

  • Image of dryer

Dryer 1 Information

  • Location: Building No/Name

  • Manufacturer:

  • Other Manufacturer:

  • Model No

  • Serial No

  • Customers asset No:

  • Dryer Type:

  • What refrigerant gas is being used:

  • Quantity of refrigerant (kg):

  • Is the dryer integral to one of the compressors?:

  • INTEGRAL? Please give details:

  • Kw Rating

  • Capacity (CFM, l/min, m3/hr, etc)

  • Port Size (inches)

  • Image of dryer

  • Other Manufacturer

Dryer 2 Information

  • Location: Building No/Name

  • Manufacturer:

  • Other Manufacturer

  • Model No

  • Serial No

  • Customers asset No:

  • Dryer Type:

  • What refrigerant gas is being used:

  • Quantity of refrigerant (kg):

  • Is the dryer integral to one of the compressors?:

  • INTEGRAL? Please give details:

  • Kw Rating

  • Capacity (CFM, l/min, m3/hr, etc)

  • Port Size (inches)

  • Image of dryer

Dryer 1 Information

  • Location: Building No/Name

  • Manufacturer:

  • Other Manufacturer

  • Model No

  • Serial No

  • Customers asset No:

  • Dryer Type:

  • What refrigerant gas is being used:

  • Quantity of refrigerant (kg):

  • Is the dryer integral to one of the compressors?:

  • INTEGRAL? Please give details:

  • Kw Rating

  • Capacity (CFM, l/min, m3/hr, etc)

  • Port Size (inches)

  • Image of dryer

Dryer 2 Information

  • Location: Building No/Name

  • Manufacturer:

  • Other Manufacturer

  • Model No

  • Serial No

  • Customers asset No:

  • Dryer Type:

  • What refrigerant gas is being used:

  • Quantity of refrigerant (kg):

  • Is the dryer integral to one of the compressors?:

  • INTEGRAL? Please give details:

  • Kw Rating

  • Capacity (CFM, l/min, m3/hr, etc)

  • Port Size (inches)

  • Image of dryer

Dryer 3 Information

  • Location: Building No/Name

  • Manufacturer:

  • Other Manufacturer

  • Model No

  • Serial No

  • Customers asset No:

  • Dryer Type:

  • What refrigerant gas is being used:

  • Quantity of refrigerant (kg):

  • Is the dryer integral to one of the compressors?:

  • INTEGRAL? Please give details:

  • Kw Rating

  • Capacity (CFM, l/min, m3/hr, etc)

  • Port Size (inches)

  • Image of dryer

Dryer 1 Information

  • Location: Building No/Name

  • Manufacturer:

  • Other Manufacturer

  • Model No

  • Serial No

  • Customers asset No:

  • Dryer Type:

  • What refrigerant gas is being used:

  • Quantity of refrigerant (kg):

  • Is the dryer integral to one of the compressors?:

  • INTEGRAL? Please give details:

  • Kw Rating

  • Capacity (CFM, l/min, m3/hr, etc)

  • Port Size (inches)

  • Image of dryer

Dryer 2 Information

  • Location: Building No/Name

  • Manufacturer:

  • Other Manufacturer

  • Model No

  • Serial No

  • Customers asset No:

  • Dryer Type:

  • What refrigerant gas is being used:

  • Quantity of refrigerant (kg):

  • Is the dryer integral to one of the compressors?:

  • INTEGRAL? Please give details:

  • Kw Rating

  • Capacity (CFM, l/min, m3/hr, etc)

  • Port Size (inches)

  • Image of dryer

Dryer 3 Information

  • Location: Building No/Name

  • Manufacturer:

  • Other Manufacturer

  • Model No

  • Serial No

  • Customers asset No:

  • Dryer Type:

  • What refrigerant gas is being used:

  • Quantity of refrigerant (kg):

  • Is the dryer integral to one of the compressors?:

  • INTEGRAL? Please give details:

  • Kw Rating

  • Capacity (CFM, l/min, m3/hr, etc)

  • Port Size (inches)

  • Image of dryer

Dryer 4 Information

  • Location: Building No/Name

  • Manufacturer:

  • Other Manufacturer

  • Model No

  • Serial No

  • Customers asset No:

  • Dryer Type:

  • What refrigerant gas is being used:

  • Quantity of refrigerant (kg):

  • Is the dryer integral to one of the compressors?:

  • INTEGRAL? Please give details:

  • Kw Rating

  • Capacity (CFM, l/min, m3/hr, etc)

  • Port Size (inches)

  • Image of dryer

Select '4' and carry out further survey(s) for additional items.

D. Receivers

  • Does the customer have any Air Receivers on site?

Continue to Filtration section.

  • How many receivers are fitted

Receiver 1

  • Location:

  • Manufacturer:

  • Other Manufacturer:

  • Serial No:

  • Customers asset No:

  • Volume (Ltrs):

  • Date of Manufacture:

  • Max Safe Working Pressure:

  • Safety Valve setting (bar/psi):

  • Safety valve thread size (BSP):

  • Take picture of Safety Valve.

  • Receiver orientation

  • Wet or Dry receiver:

  • Receiver drain type:

  • Details of receiver drain (make, model etc):

  • Image of receiver drain:

  • Is this receiver part of a compressor package (ie: is there a compressor mounted on this receiver)?

  • Details of which machine is mounted to this receiver:

  • Images of Air Receiver 1

  • Enter any additional receiver information here:

Receiver 1

  • Location:

  • Manufacturer:

  • Other Manufacturer:

  • Serial No:

  • Customers asset No:

  • Volume (Ltrs):

  • Date of Manufacture:

  • Max Safe Working Pressure:

  • Safety Valve setting (bar/psi):

  • Safety valve thread size (BSP):

  • Take picture of Safety Valve.

  • Receiver orientation

  • Wet or Dry receiver:

  • Receiver drain type:

  • Details of receiver drain (make, model etc):

  • Image of receiver drain:

  • Is this receiver part of a compressor package (ie: is there a compressor mounted on this receiver)?

  • Details of which machine is mounted to this receiver:

  • Images of Air Receiver 1

  • Enter any additional receiver information here:

Receiver 2

  • Location:

  • Manufacturer:

  • Other Manufacturer:

  • Serial No:

  • Customers asset No:

  • Volume (Ltrs):

  • Date of Manufacture:

  • Max Safe Working Pressure:

  • Safety Valve setting (bar/psi):

  • Safety valve thread size (BSP):

  • Take picture of Safety Valve.

  • Receiver orientation

  • Wet or Dry receiver:

  • Receiver drain type:

  • Details of receiver drain (make, model etc):

  • Image of receiver drain:

  • Is this receiver part of a compressor package (ie: is there a compressor mounted on this receiver)?

  • Details of which machine is mounted to this receiver:

  • Images of Air Receiver 2

  • Enter any additional receiver information here:

Receiver 1

  • Location:

  • Manufacturer:

  • Other Manufacturer:

  • Serial No:

  • Customers asset No:

  • Volume (Ltrs):

  • Date of Manufacture:

  • Max Safe Working Pressure:

  • Safety Valve setting (bar/psi):

  • Safety valve thread size (BSP):

  • Take picture of Safety Valve.

  • Receiver orientation

  • Wet or Dry receiver:

  • Receiver drain type:

  • Details of receiver drain (make, model etc):

  • Image of receiver drain:

  • Is this receiver part of a compressor package (ie: is there a compressor mounted on this receiver)?

  • Details of which machine is mounted to this receiver:

  • Images of Air Receiver 1

  • Enter any additional receiver information here:

Receiver 2

  • Location:

  • Manufacturer:

  • Other Manufacturer:

  • Serial No:

  • Customers asset No:

  • Volume (Ltrs):

  • Date of Manufacture:

  • Max Safe Working Pressure:

  • Safety Valve setting (bar/psi):

  • Safety valve thread size (BSP):

  • Take picture of Safety Valve.

  • Receiver orientation

  • Wet or Dry receiver:

  • Receiver drain type:

  • Details of receiver drain (make, model etc):

  • Image of receiver drain:

  • Is this receiver part of a compressor package (ie: is there a compressor mounted on this receiver)?

  • Details of which machine is mounted to this receiver:

  • Images of Air Receiver 2

  • Enter any additional receiver information here:

Receiver 3

  • Location:

  • Manufacturer:

  • Other Manufacturer:

  • Serial No:

  • Customers asset No:

  • Volume (Ltrs):

  • Date of Manufacture:

  • Max Safe Working Pressure:

  • Safety Valve setting (bar/psi):

  • Safety valve thread size (BSP):

  • Take picture of Safety Valve.

  • Receiver orientation

  • Wet or Dry receiver:

  • Receiver drain type:

  • Details of receiver drain (make, model etc):

  • Image of receiver drain:

  • Is this receiver part of a compressor package (ie: is there a compressor mounted on this receiver)?

  • Details of which machine is mounted to this receiver:

  • Images of Air Receiver 3

  • Enter any additional receiver information here:

Receiver 1

  • Location:

  • Manufacturer:

  • Other Manufacturer:

  • Serial No:

  • Customers asset No:

  • Volume (Ltrs):

  • Date of Manufacture:

  • Max Safe Working Pressure:

  • Safety Valve setting (bar/psi):

  • Safety valve thread size (BSP):

  • Take picture of Safety Valve.

  • Receiver orientation

  • Wet or Dry receiver:

  • Receiver drain type:

  • Details of receiver drain (make, model etc):

  • Image of receiver drain:

  • Is this receiver part of a compressor package (ie: is there a compressor mounted on this receiver)?

  • Details of which machine is mounted to this receiver:

  • Images of Air Receiver 1

  • Enter any additional receiver information here:

Receiver 2

  • Location:

  • Manufacturer:

  • Other Manufacturer:

  • Serial No:

  • Customers asset No:

  • Volume (Ltrs):

  • Date of Manufacture:

  • Max Safe Working Pressure:

  • Safety Valve setting (bar/psi):

  • Safety valve thread size (BSP):

  • Take picture of Safety Valve.

  • Receiver orientation

  • Wet or Dry receiver:

  • Receiver drain type:

  • Details of receiver drain (make, model etc):

  • Image of receiver drain:

  • Is this receiver part of a compressor package (ie: is there a compressor mounted on this receiver)?

  • Details of which machine is mounted to this receiver:

  • Images of Air Receiver 2

  • Enter any additional receiver information here:

Receiver 3

  • Location:

  • Manufacturer:

  • Other Manufacturer:

  • Serial No:

  • Customers asset No:

  • Volume (Ltrs):

  • Date of Manufacture:

  • Max Safe Working Pressure:

  • Safety Valve setting (bar/psi):

  • Safety valve thread size (BSP):

  • Take picture of Safety Valve.

  • Receiver orientation

  • Wet or Dry receiver:

  • Receiver drain type:

  • Details of receiver drain (make, model etc):

  • Image of receiver drain:

  • Is this receiver part of a compressor package (ie: is there a compressor mounted on this receiver)?

  • Details of which machine is mounted to this receiver:

  • Images of Air Receiver 3

  • Enter any additional receiver information here:

Receiver 4

  • Location:

  • Manufacturer:

  • Other Manufacturer:

  • Serial No:

  • Customers asset No:

  • Volume (Ltrs):

  • Date of Manufacture:

  • Max Safe Working Pressure:

  • Safety Valve setting (bar/psi):

  • Safety valve thread size (BSP):

  • Take picture of Safety Valve.

  • Receiver orientation

  • Wet or Dry receiver:

  • Receiver drain type:

  • Details of receiver drain (make, model etc):

  • Image of receiver drain:

  • Is this receiver part of a compressor package (ie: is there a compressor mounted on this receiver)?

  • Details of which machine is mounted to this receiver:

  • Images of Air Receiver 4

  • Enter any additional receiver information here:

Select '4' then carry out further surveys?

E. Filtration

FILTRATION ITEMS (up to 8 items on this survey)

  • Enter Filtration item 1?

Move to Condensate section.

Filter 1

  • MANUFACTURER

  • Other Manufacturer :

  • Location:

  • Model No

  • Element No

  • Port Size (inches)

  • Image of filter:

  • Automatic Drain Fitted

  • Autodrain Detail

  • Image of filter drain:

  • Enter Filtration item 2?

Move to Condensate section.

Filter 2

  • MANUFACTURER

  • Other Manufacturer :

  • Location:

  • Model No

  • Element No

  • Port Size (inches)

  • Image of filter:

  • Automatic Drain Fitted

  • Autodrain Detail

  • Image of filter drain:

  • Enter Filtration item 3?

Move to Condensate section.

Filter 3

  • MANUFACTURER

  • Other Manufacturer :

  • Location:

  • Model No

  • Element No

  • Port Size (inches)

  • Image of filter:

  • Automatic Drain Fitted

  • Autodrain Detail

  • Image of filter drain:

  • Enter Filtration item 4?

Continue to Condensate section.

Filter 4

  • MANUFACTURER

  • Other Manufacturer :

  • Location:

  • Model No

  • Element No

  • Port Size (inches)

  • Image of filter:

  • Automatic Drain Fitted

  • Autodrain Detail

  • Image of filter drain:

  • Enter Filtration item 5?

Continue to Condensate section.

Filter 5

  • MANUFACTURER

  • Other Manufacturer :

  • Location:

  • Model No

  • Element No

  • Port Size (inches)

  • Image of filter:

  • Automatic Drain Fitted

  • Autodrain Detail

  • Image of filter drain:

  • Enter Filtration item 6?

Continue to Condensate section.

Filter 6

  • MANUFACTURER

  • Other Manufacturer :

  • Location:

  • Model No

  • Element No

  • Port Size (inches)

  • Image of filter:

  • Automatic Drain Fitted

  • Autodrain Detail

  • Image of filter drain:

  • Enter Filtration item 7?

Continue to Condensate section.

Filter 7

  • MANUFACTURER

  • Other Manufacturer :

  • Location:

  • Model No

  • Element No

  • Port Size (inches)

  • Image of filter:

  • Automatic Drain Fitted

  • Autodrain Detail

  • Image of filter drain:

  • Enter Filtration item 8?

Continue to Condensate section.

Filter 8

  • MANUFACTURER

  • Other Manufacturer :

  • Location:

  • Model No

  • Element No

  • Port Size (inches)

  • Image of filter:

  • Automatic Drain Fitted

  • Autodrain Detail

  • Image of filter drain:

Other Filtration information:

  • Other filtration information:

  • Other filtration images:

F. Condensate Management

Condensate management

  • Is there a condensate management system on site?

  • Ensure customer is made aware of the Environmental regulations concerning compressor condensate:
    http://www.legislation.gov.uk/ukpga/1991/57/section/85

Condensate Management

  • How many Oil Water Separators?

Oil Water Separator 1

  • Location:

  • Manufacturer

  • Other Manufacturer:

  • Do you know the model number?

  • Model No:

  • Serial No:

  • Customers Asset No :

  • Enter free text:

  • ANY other information, eg; service kit ref:

  • Take plenty of pictures and measurements for identification.

  • Enter free text:

  • ANY other information, eg; service kit ref:

  • Take Picture of OWS 1

Oil Water Separator 1

  • Location:

  • Manufacturer

  • Other Manufacturer:

  • Do you know the model number?

  • Model No:

  • Serial No:

  • Customers Asset No :

  • Enter free text:

  • ANY other information, eg; service kit ref:

  • Take plenty of pictures and measurements for identification.

  • Enter free text:

  • ANY other information, eg; service kit ref:

  • Take Picture of OWS 1

Oil Water Separator 2

  • Location:

  • Manufacturer

  • Other Manufacturer:

  • Do you know the model number?

  • Model No:

  • Serial No:

  • Customers Asset No :

  • ANY other information, eg; service kit ref:

  • Take plenty of pictures and measurements for identification.

  • ANY other information, eg; service kit ref:

  • Take Picture of OWS 2

Oil Water Separator 1

  • Location:

  • Manufacturer

  • Other Manufacturer:

  • Do you know the model number?

  • Model No:

  • Serial No:

  • Customers Asset No :

  • ANY other information, eg; service kit ref:

  • Take plenty of pictures and measurements for identification.

  • Enter free text:

  • ANY other information, eg; service kit ref:

  • Take Picture of OWS 1

Oil Water Separator 2

  • Location:

  • Manufacturer

  • Other Manufacturer:

  • Do you know the model number?

  • Model No:

  • Serial No:

  • Customers Asset No :

  • ANY other information, eg; service kit ref:

  • Take plenty of pictures and measurements for identification.

  • Enter free text:

  • ANY other information, eg; service kit ref:

  • Take Picture of OWS 2

Oil Water Separator 3

  • Location:

  • Manufacturer

  • Other Manufacturer:

  • Do you know the model number?

  • Model No:

  • Serial No:

  • Customers Asset No :

  • ANY other information, eg; service kit ref:

  • Take plenty of pictures and measurements for identification.

  • Enter free text:

  • ANY other information, eg; service kit ref:

  • Take Picture of OWS 3

Oil Water Separator 1

  • Location:

  • Manufacturer

  • Other Manufacturer:

  • Do you know the model number?

  • Model No:

  • Serial No:

  • Customers Asset No :

  • ANY other information, eg; service kit ref:

  • Take plenty of pictures and measurements for identification.

  • Enter free text:

  • ANY other information, eg; service kit ref:

  • Take Picture of OWS 1

Oil Water Separator 2

  • Location:

  • Manufacturer

  • Other Manufacturer:

  • Do you know the model number?

  • Model No:

  • Serial No:

  • Customers Asset No :

  • ANY other information, eg; service kit ref:

  • Take plenty of pictures and measurements for identification.

  • Enter free text:

  • ANY other information, eg; service kit ref:

  • Take Picture of OWS 2

Oil Water Separator 3

  • Location:

  • Manufacturer

  • Other Manufacturer:

  • Do you know the model number?

  • Model No:

  • Serial No:

  • Customers Asset No :

  • ANY other information, eg; service kit ref:

  • Take plenty of pictures and measurements for identification.

  • Enter free text:

  • ANY other information, eg; service kit ref:

  • Take Picture of OWS 3

Oil Water Separator 4

  • Location:

  • Manufacturer

  • Other Manufacturer:

  • Do you know the model number?

  • Model No:

  • Serial No:

  • Customers Asset No :

  • ANY other information, eg; service kit ref:

  • Take plenty of pictures and measurements for identification.

  • Enter free text:

  • ANY other information, eg; service kit ref:

  • Take Picture of OWS 4

Select '4' and carry out further surveys.

Any other condensate information:

  • Any other condensate equipment information?

Continue to Additional Technical Information.

  • Images of additional condensate equipment.

  • Additional condensate equipment details:

G. Additional Technical Information

Additional Technical Information

  • Is there a compressor control system installed?

  • Details of Compressor Control Equipment:

  • Images of Compressor Control Equipment :

  • Any other Technical Information:

  • Additional images:

H. Additional Site Information

Additional Site Information

  • Add Free Text

  • Are Motivair Stickers visible on all equipment

  • * * * * * Place Motivair Stickers and Service Labels * * * * *

Any other equipment information?

  • Is there any 'Other' equipment on site not included in this survey?

Continue to Sign Off

  • Details of 'Other' equipment on site not surveyed on this visit? Pass lead to sales team. Please give details below:

  • PASS LEAD TO SALES TEAM.

  • Details of 'Other' equipment:

  • Images of 'Other' equipment

I. Verification and Signature

  • Are all images clear and visible?

  • Name

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.