Information

  • Job Name / Unit # / Building

  • Date

  • Prepared by

Dwelling valves

  • Dwelling Isolation valves shut off

  • Which valve does not shut off properly

  • Does the dwelling have a tempering valve

  • Temperature of outlet of tempering valve

  • Is the tempering valve within date of 5 years

  • Water leaks on Tempering valve

Main Bathroom

  • Basin Sink

  • Basin Sink Mixer

  • Basin Tap Movement

  • Sink Mixer Flexi Hoses

  • Type of hot and cold water valves

  • Valve condition

  • Basin Tap Movement

  • Sink Mixer Flexi Hoses

  • Tapware condition

  • Basin Tap Movement

  • Sink Mixer Flexi Hoses

  • Toilet Pan

  • Toilet seat

  • Toilet Cistern

  • Toilet outlet valve

  • Toilet Buttons

  • Toilet flexi hose

  • Shower Condition

  • Shower Breech Test

  • Shower Type

  • Mixer Condition

  • Hot and Cold Tap valves

  • Shower Seal inspection / spray test

  • Bath Present in Bathroom

  • Bath tap type

  • Mixer Condition

  • Hot and Cold Tap valves

Second Bathroom

  • Is there a second bathroom in the dwelling

  • Basin Sink

  • Basin Sink Mixer

  • Basin Tap Movement

  • Sink Mixer Flexi Hoses

  • Type of hot and cold water valves

  • Valve condition

  • Basin Tap Movement

  • Sink Mixer Flexi Hoses

  • Tapware condition

  • Basin Tap Movement

  • Sink Mixer Flexi Hoses

  • Toilet Pan

  • Toilet seat

  • Toilet Cistern

  • Toilet outlet valve

  • Toilet Buttons

  • Toilet flexi hose

  • Shower Condition

  • Shower Breech Test

  • Shower Type

  • Mixer Condition

  • Hot and Cold Tap valves

  • Shower Seal inspection / spray test

  • Bath Present in Bathroom

  • Bath tap type

  • Mixer Condition

  • Hot and Cold Tap valves

Kitchen

  • Kitchen Sink Tap Type

  • Kitchen Sink Mixer

  • Sink Mixer Flexi Hoses

  • Kitchen Tap movement

  • Type of hot and cold valves

  • Valve condition

  • Kitchen Tap movement

  • Sink Mixer Flexi Hoses

  • Tapware condition

  • Kitchen Tap movement

  • Sink Trap

Hot Water Meter

  • Hot water meter condition

  • Hot water meter on flexi hoses

  • Flexi condition

Laundry

  • Laundry Sink Type

  • Mixer Condition

  • Sink Mixer Flexi Hoses

  • Hot and Cold Tap valves

  • Sink Trap

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.