Pump house monthly report

• Audit Title

• Document No.

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Mandatory Information

• Is all Risk Management paperwork in place?

  Yes

  No

Pumps

• Add Pump

Pump

• Serial Number

• Hours Run

• Pump Greased

  Yes

  No

• Meter Reading

• Panel Lights

  Pass

  Fail

• Comments

Structure

• Pump Discharge Flaps

  Pass

  Fail

• Pump Discharge Reflux Valves

  Pass

  Fail

• Penstock

  Open

  Closed

• Weed Screen

  Pass

  Fail

• Building Condition

  Pass

  Fail

Safety Equipment and Signage

• Add Safety Equipment

Safety Equipment

• Type

• In Service Date

  Yes

  No

• All signage visible and defect free

  Yes

  No

• Reports of any faults

Access and Ground Conditions

• Ladders and Walkways

  Pass

  Fail

• Perimeter Fencing and Gates

  Pass

  Fail

• Ground Conditions

  Pass

  Fail

• Person carrying out inspection

Person

• Signature

  Sign