Title Page
-
Store Name & Store Number
-
Location
-
SITE TYPE
- Woolworths SMKT
- Woolworths Metro Store
- Dan Murphy
- BWS/Liquor
- Petrol
- Area Office-Woolworths
-
Work Order No:
-
Conducted on
-
Prepared by
Inspection Details: PHOTOGRAPHIC EVIDENCE REQUIRED AS PROOF OF INSPECTION. You must take before & after pictures of components replaced/rectified etc.
Liquid Receivers
-
Does site have receivers?
-
How Many Receivers are on Site?
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- Non
-
Liquid receiver details
Receiver
-
Manufacturer:
-
Receiver Model /Serial Number(Picture)
-
Receiver Model /Serial Number(Input text)
-
Type of Receiver:
-
Location of Receiver:
-
Physical Condition:
-
General Comment on Receivers
PRESSURE RELIEF VALVE(S)
-
How many Pressure Relief Valves are on Site?
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- Non
-
How many Pressure Relief Valve require replacement as per report provided Woolworths?
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- Non
-
Pressure Relief Valve details
Valve
-
Pressure Valve No :1
-
Do you have Replacement valve ?
-
Have you replaced valve?
-
General Comment:
-
Design Pressure Rating? PA or PSI
-
Pressure Relief Gauge fitted?
-
Add media
-
Is the Pressure Relief Gauge at Zero:
-
Has Burst Disc Failed?
-
Supporting Picture
-
Has Valve Seal Broken?
-
Supporting Picture
-
Vented to Atmosphere: Yes / No *If No, What is required to establish Vent: H.D Pipe / Fittings Size / Requirements:
-
Does PRV vent to Atmosphere?
-
What is required (Scope of work) to vent outside?
ELECTRIC DUCT HEATER INSPECTION
-
Note: HVAC MSSB should contain supply C/B for Heater Banks - Amps to be measured at supply
-
Does site have electric duct heaters?
-
How Many Duct heaters are on-site?
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- Non
-
DUCT HEATERS DETAILS
DUCT HEATERS
-
Electric Duct Heater Bank No1: Operational
-
Power Supply to Electric Duct Heater Bank No1
-
Running Amps?
-
Electric Duct Heater Bank No1- Location:
-
Are Heaters Accessible: Yes / No *If No, what is required to access - comment + photos + dimensions:
-
Any Loose Connections? or discolored or sign of deterioration on connections
-
Evidence via Picture
-
Does heater Require Replacement?
-
Details on replacement
-
Thermal Coating Compromised
-
General Comments if any?
HVAC SYSTEM
-
What type of equipment is on site which serves the trading floor?
-
Plant Type?
-
Type of refrigerant ?
-
General Condition (Visual inspection)
-
Pictures of the component
DX Plant Compressors:
-
-
Compressor Location?
-
Make:
-
Model:
-
Pictures of Compressors
Condenser:
-
How Many Condensers are on site?
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- Non
-
What is the condition of Condensers?
-
Pictures of the Condensers.
-
General Comment
HVAC Controller
-
What Type of HVAC controller is on-site?
-
Picture of MSSB & Controller
-
General Comment:
SIGN OFF
-
Have you completed Maintenance Authority form?
-
Picture of MA
-
Have you cleaned up your work area which includes removal of all rubbish?
-
Name & Sign off