Title Page

  • Conducted on

  • Prepared by

  • Location

Customer Information

  • Customer / Client Name

  • Address

  • Customer Contact Name

  • Contact No.

  • Email

Equipment and Configuration

  • New Proposed Unit

  • Configuration

Site Information

  • Department / Level / Room

  • Rooms current use

  • Current system installed if any.

  • Available Power Supply

  • AERB Registration and address as per AERB registration

  • PNDT Certificate

Examination Room

  • Upload Pictures

  • Wall thickness and shield material Brick / Concrete or lead Partition.

  • Slab thickness.

  • Floor type Concrete / Vinyl / Tiling

  • Clear ht. below ceiling and beam

  • Room Size

Console Room

  • Upload Pictures

  • Floor type Concrete / Vinyl or Tiling

  • Clear ht. below ceiling and beam

  • Room Size

Technical Room

  • Upload Pictures

  • Floor type Concrete / Vinyl or Tiling

  • Clear ht. below Ceiling and beam

  • Room Size.

Transportation Path

  • Local Permission required if any?

  • Storage Space available or not?

  • Unloading feasibility - Day or Night

  • Wall Opening in external wall

  • Lift size. (1) Clear door opening (2) Lift cabin size (3) Weighing Capacity

  • Clear corridor size.

  • Temporary Platform required?

  • Crane required Hydra / Forklift / Telescopic

  • Floor Level

  • Standard or Nonstandard

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.