Rounding - MS

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Marble Falls Specialty Clinic 800 W Hwy 71 Marble Falls Texas 78654
  Address

Fire Protection -

• 1 - Gauge System Pressure

• 2 - Gauge System Pressure

• 3 - Gauge System Pressure

• 4 - Gauge System Pressure

• 5 - Gauge System Pressure

Domestic Cold Water Pumps

• Domestic Cold Water Pump 1

  On

  Off

  StandBy

• Domestic Cold Water Pump 2

  On

  Off

  StandBy

Water Softner

• Water Softner

  On

  Off

  StandBy

• Salt Added

  Yes

  No

Water Heaters

• Water Heater - 1

  On

  Off

  StandBy

• Water Heater - 2

  On

  Off

  StandBy

• Hot Water Temp Gauge 140*

• Hot water mixing valve Temp 115*

BOILERS

• Boiler - 1

  On

  Off

  StandBy

• TEMP ________*

• Boiler - 2

  On

  Off

  StandBy

• TEMP ______*

• Heating Water RETURN Temp *

• Heating Water SUPPLY Temp*

Hot Water Pumps

• Hot Water Pump - 1

  On

  Off

  StandBy

• Temp

• Hot Water Pump - 2

  On

  Off

  StandBy

• Temp

• Hot Water Pump - 3

  On

  Off

  StandBy

• Temp

Chilled Water Pumps

• Chilled Water Pump - 1

  On

  Off

  StandBy

• Temp in ___

• Temp OUT ____

• Chilled Water Pump - 2

  On

  Off

  StandBy

• Temp In ____

• Temp Out ____

• Chilled Water Pump - 3

  On

  Off

  StandBy

• Temp In _____

• Temp Out ____

Chillers

• Chiller - 1

  On

  Off

  StandBy

• Temp In

• Temp Out

• Chiller - 2

  On

  Off

  StandBy

• Temp In

• Temp Out

PROPANE (NOTE PROPANE Calls out at about 9%)

• Select from range

• Add signature

  Sign

• Select date

  Date