PPM VISIT RECORD | 3 Monthly

• Conducted on

  Date

• Prepared by

• Location
  Address

Safety

• Was the Plant Room secured on arrival

  Yes

  No

• Are you aware of your escape routes and fire exit locations

  Yes

  No

• Have you got the correct tools to carry out the works safely and correctly

  Yes

  No

3 Monthly Maintenance Tasks

• Exercised Valves on Site to Ensure Free and Working

  Select PRI LTHW Circuit Pass PRI LTHW Fail PRI LTHW Valve Seized PRI LTHW Handle missing SEC LTHW Circuit Pass SEC LTHW Fail SEC LTHW Valve Seized SEC LTHW Handle missing HWS Circuit Pass HWS Circuit Fail HWS Circuit Valve Seized HWS Circuit Handle missing

  • PRI LTHW Circuit Pass
  • PRI LTHW Fail
  • PRI LTHW Valve Seized
  • PRI LTHW Handle missing
  • SEC LTHW Circuit Pass
  • SEC LTHW Fail
  • SEC LTHW Valve Seized
  • SEC LTHW Handle missing
  • HWS Circuit Pass
  • HWS Circuit Fail
  • HWS Circuit Valve Seized
  • HWS Circuit Handle missing

• Inline filters inspected

  Select Yes No Gasket / O ring replaced Non on site

  • Yes
  • No
  • Gasket / O ring replaced
  • Non on site

• Cleaning of Plant room sweep out and clear rubbish

  Select Pass Waste removal team required

  • Pass
  • Waste removal team required

• Cleaned Dirt Air Separators

  Pass

  Fail

  N/A

• Water Sample Visual Inspection

  Select Water is clear Water is black Water is 0range Debris is present in water Odour is present to water No odour is present to water Inhibitor / Treatment Required

  • Water is clear
  • Water is black
  • Water is 0range
  • Debris is present in water
  • Odour is present to water
  • No odour is present to water
  • Inhibitor / Treatment Required

• Block Risers Strainer Cleaning & Valve Testing

  Yes

  No

  N/A

• Has the system been dosed with Inhibitor/ Cleaning solution

  Select Inhibitor added (Please specify brand) Cleaner added (Please specify brand) No

  • Inhibitor added (Please specify brand)
  • Cleaner added (Please specify brand)
  • No

• Primary Circuit System Pressure (BAR)

• Secondary Circuit if Applicable (BAR)

• Flow Temperature Exiting Plant Room Degrees C

• Return Temperature Entering Plant Room Degrees C

• PPM Visit Completed

  Sign