Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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General Inspection:
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General Appearance:
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Good
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Fair
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Poor
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Leaks, dripping, running faucets and valves
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Maintenance history
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Supply adequacy
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Sanitation hazards
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Drain & waste connection
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Backflow protection
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Cross connections
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Fixture quantity
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Fixture types & conditions
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Handicapped fixtures
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Female facilities
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Metal pipe & fittings corrosion
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Pipe joints & sealing
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Pipe insulation
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Hanger supports & clamps
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Filters
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Building user comments
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Water System
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Water pressure adequate
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Main cutoff operable
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Pump condition
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Odors, tastes
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Water heating temperature setting
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Insulation condition
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Sanitary & Storm System
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Flow adequate
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Floor drains
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Gradient
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Cleanouts access
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Chemical resistance
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On-site deposal system
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Code Requirements
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EPA/locals permits
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Other
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Fire Protection System
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Regular inspections
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Complies with code
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Hose cabinets functional
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Sprinkler heads operable
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Controls operable
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Water pressure sufficient
