Qube Third Party Quarantine Inspection Checklist - Ethyl Formate

• PSB Qube Third Party Quarantine Inspection Checklist - Ethyl Formate Blue Tag

• Information in this audit will track the inspection across multiple stages, please ensure entries in this audit are accurate

• Document Number

• Type of Asset

  Select

• Asset Number

Third Party Asset - Checklist

• Does the Asset need an External Verification

  Yes

  No

• After a full Quarantine Inspection on all External surfaces the asset is clean and free from discernible evidence of QRM

  Yes

  No

• Is there a Blue Label affixed to the Asset?

  Yes

  No

• Is there a Blue Seal affixed to the Asset?

  Yes

  No

• Is the Asset wrapped and therefore does not require a Blue Seal?

  Yes

  No

• Is there a Blue Label affixed to the Asset?

  Yes

  No

• Is there a Blue Seal affixed to the Asset

  Yes

  No

• Is the Asset wrapped and therefore does not require a Blue Seal?

  Yes

  No

Treatment and Release Information

Treatment Information

• Type of Chemical Used

  Select

Fumigation Treatment Certificate

• Site - 42 Ulm Place Hazelmere WA 6055

• Brand Name - Ingredients Solutions Australia

• Active Components - Ethyl Formate (EF) @ 90g / m3 in Nitrogen

• Equipment - Fume8 Vaporizer and Nitrogen Gas Banks

Fumigation Information

• Amount of Ethyl Formate Used

  Select

• Gassing Time and Date

  Date

• Venting Time and Date

  Date

• Zero PPM Reading Achieved

Fumigator Release

• Fumigator in Charge Name

  Select

• Fumigator in Charge Signature

  Sign

• Other People Present

  Select

• Is Company Quarantine approval required?

  Yes

  No

  N/A

• Contact details of Company Quarantine Personnel responsible for approval

• Residual Date

  Date

• Is Company Quarantine approval required?

  Yes

  No

  N/A

• Contact details of Company Quarantine Personnel responsible for approval

  Yes

  No

  N/A

• Rodent Bait placement date

  Date

• Photo of Rodent Bait placed in asset

  Media

• Is Company Quarantine approval required?

  Yes

  No

  N/A

• Contact details of Company Quarantine Personnel responsible for approval

  Yes

  No

  N/A

• Gassing Date and Time

  Date

• Is the Asset being vented onsite?

  Yes

  No

• Venting Date and Time

  Date

• Venting must be selected in Carry Over Work and displayed on the Blue Label on the asset

Photos

• Photo of Blue Label on asset

  Media

• Photo of Data Plate

  Media

• Residual Date

  Date

• Photo of Completed Treatment Sticker

  Media

• Is a Blue Seal required on the Asset

  Yes

  No

• Photo of Blue Seal

  Media

Quarantine Release Signoff and Authorization

• Date

  Date

• Quarantine Inspector Name

  Select

• Quarantine Inspector Signature

  Sign

• Carry Over Work

  Select

• Cleared for Movement to:

  Select