Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

  • Work Order Number

Untitled Page

(T)ools, (S)afety Equipment and (M)aterials

  • Flashlight

  • Portable Pump

  • Cleaning materials

Safety Guidelines

  • Follow Confined Space Entry Procedures

  • Use proper personal protective equipment

  • Record and report any equipment damage or deficiencies found while performing this maintenance task

  • Watch out for snakes, bugs, rats, and other poisonous/dangerous materials

  • Use barricade around the access port

Maintenance Procedures

  • Pump out any water in the vault

  • Check for evidence of leakage from the glycol system

  • Cycle isolation valves shut/open

  • Note condition of piping insulation

  • Note condition of piping/wall sealants

  • Check the condition of the access ladder and cover seal

  • Wipe down the piping and vault

Maintenance hours

  • How much time was spent on this work order?

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.