Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
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Work Order Number
Untitled Page
(T)ools, (S)afety Equipment and (M)aterials
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Flashlight
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Portable Pump
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Cleaning materials
Safety Guidelines
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Follow Confined Space Entry Procedures
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Use proper personal protective equipment
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Record and report any equipment damage or deficiencies found while performing this maintenance task
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Watch out for snakes, bugs, rats, and other poisonous/dangerous materials
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Use barricade around the access port
Maintenance Procedures
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Pump out any water in the vault
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Check for evidence of leakage from the glycol system
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Cycle isolation valves shut/open
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Note condition of piping insulation
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Note condition of piping/wall sealants
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Check the condition of the access ladder and cover seal
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Wipe down the piping and vault
Maintenance hours
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How much time was spent on this work order?