Title Page

  • Conducted on

  • Prepared by

  • Customer Name

  • Location
  • Were Toll roads used to get to site?

  • Please give details

Commissioning Report

Propelair system components installed

  • Lid colour

  • Flush mechanism

  • Type of control module

  • Type of battery box

  • Type of charger

  • For each washroom being surveyed - please come back to this point to add a washroom. A checklist will appear below this title.

  • Washroom.

Washroom Details

  • Building Name (if relevant)

  • Floor level within building

  • Type of washroom

  • Number of toilets within washroom.

  • Take a photo of the washroom.

  • Service voids used to access Propelair components

  • Void Accessibility

  • Combination code:

  • Please give details

  • Removable IPS panels.

  • Panel Type

  • Please specify

  • Height of panels

Checklist

  • 1. Do the lid and seat move freely and independently of one another?

  • Please list the cubicles where issues were found. If remedial action was taken, please state what was done. If further work needs doing, please state what needs to be done.

  • 2. Are all seals and buffers for seat & lid present and correct including hinge pin covers/clips?

  • Please list the cubicles where issues were found. If remedial action was taken, please state what was done. If further work needs doing, please state what needs to be done.

  • 3. Do a test flush. Is a full flush delivered? (Delivering air & water and clearing contents of toilet).

  • Please list the cubicles where issues were found. If remedial action was taken, please state what was done. If further work needs doing, please state what needs to be done.

  • 4. Is the water trap restored to the correct level?

  • Please list the cubicles where issues were found. If remedial action was taken, please state what was done. If further work needs doing, please state what needs to be done.

  • 5. Does the latch engage correctly and keep the lid closed during the flush?

  • Please list the cubicles where issues were found. If remedial action was taken, please state what was done. If further work needs doing, please state what needs to be done.

  • 6. Is the mastic complete (around the pan against the paneling, and around the pan against the floor) neatly finished?

  • Please list the cubicles where issues were found. If remedial action was taken, please state what was done. If further work needs doing, please state what needs to be done.

  • 7. Is the pan securely fixed to the floor?

  • Please list the cubicles where issues were found. If remedial action was taken, please state what was done. If further work needs doing, please state what needs to be done.

  • 8. Have the user info stickers have been applied?

  • Has the customer put up their own information signs?

  • 9. Is each battery charger wired in to fuse spur with a 3Amp fuse and is switched on?

  • Please list the cubicles where issues were found. If remedial action was taken, please state what was done. If further work needs doing, please state what needs to be done.

  • 10. Is the battery box readily accessible and secure?

  • Please list the cubicles where issues were found. If remedial action was taken, please state what was done. If further work needs doing, please state what needs to be done.

  • 11. Has the cistern lid been replaced and secured with screw provided?

  • Please list the cubicles where issues were found. If remedial action was taken, please state what was done. If further work needs doing, please state what needs to be done.

  • 12. All wired connections are correct, neat and secured with cable ties within cistern enclosure?

  • Please list the cubicles where issues were found. If remedial action was taken, please state what was done. If further work needs doing, please state what needs to be done.

  • 13. Power sensor connected

  • 14. Are all 4 screws fitted to secure the air pump motor?

  • Please list the cubicles where issues were found. If remedial action was taken, please state what was done. If further work needs doing, please state what needs to be done.

  • 15. Is the cistern fixed to wall level with the anti-vibration washers provided and set at the correct height? (600mm minimum)

  • Please list the cubicles where issues were found. If remedial action was taken, please state what was done. If further work needs doing, please state what needs to be done.

  • 16. Is the breather tube correct, not pinched and facing away from the secondary overflow point?

  • Please list the cubicles where issues were found. If remedial action was taken, please state what was done. If further work needs doing, please state what needs to be done.

  • 17. Is the cistern water level correct and replenished within 30 seconds?

  • Please list the cubicles where issues were found. If remedial action was taken, please state what was done. If further work needs doing, please state what needs to be done.

  • 18. Flow restrictor is still present inside water inlet valve?

  • Please list the cubicles where issues were found. If remedial action was taken, please state what was done. If further work needs doing, please state what needs to be done.

  • 19. Water supply

  • Please give details

  • 20. Water hose is installed with a downwards gradient and NOT sagging?

  • Please list the cubicles where issues were found. If remedial action was taken, please state what was done. If further work needs doing, please state what needs to be done.

  • 21. ALL hoses correctly installed? (No kinks; nothing trapped or split and assembled incorrectly)

  • Please list the cubicles where issues were found. If remedial action was taken, please state what was done. If further work needs doing, please state what needs to be done.

  • 22. Bottom panel is cut correctly? It does NOT impede either water or air connections to the manifold?

  • Please list the cubicles where issues were found. If remedial action was taken, please state what was done. If further work needs doing, please state what needs to be done.

  • 23. Have all water connections been inspected for leaks and none were found?

  • Please list the cubicles where issues were found. If remedial action was taken, please state what was done. If further work needs doing, please state what needs to be done.

  • 24. Has the secondary overflow pipe been installed correctly with a one way valve?

  • Please list the cubicles where issues were found. If remedial action was taken, please state what was done. If further work needs doing, please state what needs to be done.

  • 25. Has the 50mm waste been inspected & confirmed to be facing downstream and not protruding into the 100mm waste pipe?

  • Is it possible to inspect the 50mm waste without removing a pan?

  • 26. Has the venting been inspected and confirmed to have been installed correctly?

  • What materials are required to correct it?

  • Approximately how many hours will it take to correct the venting?

  • How many people are required to do the job in this amount of time?

  • Please give details:

  • 27. Have Air Admittance Valves been installed?

  • 28. Is there rodding access?

  • 29. Has the void area been cleared of rubbish

  • 30. Drain Camera inspection performed?

  • Please enter any additional notes on the installation.

  • Take any additional photos if required.

Signature of surveyor, and of the client to confirm that this survey has been witnessed and understood.

  • Commissioned By:

  • Commissioned By:

  • Time and date.

  • Name of person signing on behalf of the client:

  • Client signature.

  • Email address.

  • Time of departure.

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.