MPS template 5

• Audit Title

• Site

• Document No.

• Client

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• General description of the location

• General photos of the location

  Media

• Equipment to be checked

#

• Equipment TAG

Equipment

Mechanical

• All devices properly installed (according to P&ID)?

  Yes

  No

• Helping Drawing

  Drawing

• ----- Re-checking section ------

Re-chekcing #

• Date and time of the re-checking

  Date

• All devices properly installed (according to P&ID)?

  Yes

  No

• Helping Drawing

  Drawing

• All devices - final and correct implementation?

  Off

  On

• Date and time of the final and correct implementation

  Date

• Photos of the final and correct implementation (usually 3 photos)

  Media

Instrument

• All devices properly installed (according to P&ID)?

  Yes

  No

• Helping Drawing

  Drawing

• ----- Re-checking section ------

Re-chekcing #

• Date and time of the re-checking

  Date

• All devices properly installed (according to P&ID)?

  Yes

  No

• Helping Drawing

  Drawing

• All devices - final and correct implementation?

  Off

  On

• Date and time of the final and correct implementation

  Date

• Photos of the final and correct implementation (usually 5 photos)

  Media

TAG

• All devices properly installed (according to P&ID)?

  Yes

  No

• Helping Drawing

  Drawing

• ----- Re-checking section ------

Re-chekcing #

• Date and time of the re-checking

  Date

• All devices properly installed (according to P&ID)?

  Yes

  No

• Helping Drawing

  Drawing

Serial number of the device/devices

• Photo of the serial number nameplate (one picture for every device)

  Media

Final checking of this unit

• All devices - final and correct implementation?

  Off

  On

• Importance of the problem (1 - trivial... 5 - very important)

• Deadline

  Date

• Date and time of the final and correct implementation

  Date

• Photos of the final and correct implementation (usually 5 photos)

  Media