Sand W-21 inspection (Multiple Rounds per Shift)

• Site conducted

  Select

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date
• Location
  Address

W-21 Under Flow

• Is XV-345 (W-21) in use?

  Yes

  No

  locked Out

• Is the flush valve (XV-502) in use?

  Yes

  No

  locked Out

• Is XV-347 (W-22) in use?

  Yes

  No

  locked Out

• Is the flush valve (XV-501) in use?

  Yes

  No

  locked Out

• What condition is the rupture disk in? (PSE-344)

  Ok

  Valved out

• Is the valves and piping in good condition?

  Yes

  No

• Is the heat trace and insulation in good condition?

  Yes

  No

W-21 Over Flow

• Is XV-221 (W-21A) in use?

  Yes

  No

  locked Out

• Is the manual flush valve in use?

  Yes

  No

  locked Out

• Is XV-224 (W-21B) in use?

  Yes

  No

  locked Out

• Is the manual flush valve in use?

  Yes

  No

  locked Out

• Is XV-227 (W-22A) in use?

  Yes

  No

  locked Out

• Is the manual flush valve in use?

  Yes

  No

  locked Out

• Is XV-230 (W-22B) in use?

  Yes

  No

  locked Out

• Is the manual flush valve in use?

  Yes

  No

  locked Out

• Is FV-272A in use?

  Open

  Close

• What condition is the rupture disk in? (PSE-220)

  Ok

  Valved out

• Is FV-272B in use?

  Open

  Close

• What condition is the rupture disk in? (PSE-231)

  Ok

  Valved out

• Is the valves and piping in good condition?

  Yes

  No

• Is the house keeping good?

  Yes

  No

• Are there any safety issues or problems with W-21?

  Safe

  At Risk

  N/A

• Operator

  Sign

• Yes

  No

  N/A