Title Page

  • Document No.

  • Prepared By

  • Day or Night Shift

  • Select date

Pump Station Routes

  • Choose Pump Station

  • Enter Date and Time

  • Are All Lights On The Pump Deck?

  • Is The Pump Deck Clean?

  • Are All Lights On In MCC Room?

  • Is MCC Room Clean?

  • Enter High Quality Sump Dicharge Flow

  • Enter High Quality Sump Total Flow

  • Enter High Quality Sump Level

  • Enter High Quality Sump Discharge Pressure

  • Enter Medium Quality Sump Discharge Flow

  • Enter Medium Quality Sump Total Flow

  • Enter Medium Quality Sump Sump Level

  • Enter Medium Quality Sump Discharge Pressure

  • Enter Low Quality Sump Dicharge Flow

  • Enter Low Quality Sump Total Flow

  • Enter Low Quality Sump Level

  • Enter Low Quality Sump Dicharge Pressure

  • Enter Start Time

  • Is Area Clean Of Debris?

  • Are Their Any Leaks Present?

  • Enter Start Time

  • Is ACC Pump Room Clean?

  • Is ACC MCC Room Clean?

  • Are All Lights On In ACC Pump Room?

  • Are All Lights On In ACC MCC Room?

  • Enter ACC Bypass Flow

  • Enter Mill 330 Flow

  • Enter Mill 340 Flow

  • Enter Mill 350 Flow

  • Enter Mill 360 Flow

  • Enter Start Time

  • Is Acid Well #1 Pump Room Clean?

  • Is Acid Well #1 MCC Room Clean?

  • Are Acid Well #1 All Lights On In Pump Room?

  • Are Acid Well #1 All Lights On In MCC Room?

  • Enter Acid Well #1 Discharge Flow

  • Enter Acid Well #1 Total Flow

  • Enter Acid Well #1 Discharge Pressure

  • Enter Acid Well #1 Depth To Water

  • Enter Start Time

  • Is Acid Well #2 Pump Room Clean?

  • Is Acid Well #2 MCC Room Clean?

  • Are Acid Well #2 All Lights On In Pump Room?

  • Are Acid Well #2 All Lights On In MCC Room?

  • Enter Acid Well #2 Discharge Flow

  • Enter Acid Well #2 Total Flow

  • Enter Acid Well #2 Discharge Pressure

  • Enter Acid Well #2 Depth To Water

  • Enter Start Time

  • Is Pump Room Clean?

  • Is Acid Well #3 MCC Room Clean?

  • Are Acid Well #3 All Lights On In Pump Room?

  • Are Acid Well #3 All Lights On In MCC Room?

  • Enter Acid Well #3 Discharge Flow

  • Enter Acid Well #3 Total Flow

  • Enter Acid Well #3 Discharge Pressure

  • Enter Acid Well #3 Depth To Water

  • Enter Start Time

  • Are All Bingham Booster Lights On In Pump Room?

  • Are All Bingham Booster Lights On In MCC Room?

  • Is Bingham Booster Pump Room Clean?

  • Is Bingham Booster MCC Room Clean?

  • Enter Bingham Booster Sump Level

  • Are Any Pumps On?

  • Choose Running Pump

  • Enter PP-11 Discharge Pressure

  • Enter PP-12 Discharge Pressure

  • Enter PP-13 Discharge Pressure

  • Enter PP-14 Discharge Pressure

  • Select date

  • Is Alluvial Area Clean?

  • Are Their Any Leaks?

  • Enter Allucial Well Total Flow

  • Enter Allucial Well Depth To Water (DTW)

  • Enter Allucial Well Discharge Flow

  • Enter Start Time

  • Is Cut Of Wall Pump Room Clean?

  • Is Cut Of Wall MCC Room Clean?

  • Are All Cut Of Wall Lights On In Pump Room?

  • Are All Cut Of Wall Lights On In MCC Room?

  • Enter Cut Off Wall Discharge Flow

  • Enter Cut Off Wall Total Flow

  • Enter Cut Off Wall Discharge Pressure

  • Enter Cut Off Wall Sump Level

  • Enter Start Time

  • Is Mascotte Tunnel area Clean?

  • Enter Mascotte Tunnel Discharge Flow

  • Enter Mascotte Channel Total Flow

  • Enter Start Time

  • Is Channel Well Area Clean?

  • Enter Channel Well Discharge Flow

  • Enter Channel Well Total Flow

  • Enter Start Time

  • Are All Clean Water Well Lights On In Pump Room?

  • Are All Clean Water Well Lights On In MCC Room?

  • Is Clean Water Well Pump Room Clean?

  • Is Clean Water Well MCC Room Clean?

  • Enter Clean Water Discharge Flow

  • Enter Clean Water Total Flow

  • Enter Clean Water Depth To Water (DTW)

  • Enter Clean Water PP-26 Discharge Pressure

  • Enter Clean Water PP-27 Discharge Pressure

  • Enter Clean Water Differential Pressure

  • Enter Start Time

  • Is Copperton Chlorinator Are Clean?

  • Is Copperton Chlorinator Lights Working?

  • Enter Chlorine Bottle Weight

  • Enter Start Time

  • Is Culinary Well #1 Area Clean?

  • Is Culinary Well #1 Lights Working?

  • Enter Culianary Well #1 Discharge Flow

  • Enter Culianary Well #1 Depth To Water (DTW)

  • Enter Culianary Well #1 Total Flow

  • Enter Start Time

  • Is Culinary Well #2 Area Clean?

  • Is Culinary Well #2 Lights Working?

  • Enter Culianary Well #2 Discharge Flow

  • Enter Culianary Well #2 Depth To Water (DTW)

  • Enter Culianary Well #2 Total Flow

  • Enter Start Time

  • Is Culinary Well #3 Area Clean?

  • Is Culinary Well #3 Lights Working?

  • Enter Culianary Well #3 Discharge Flow

  • Enter Culianary Well #3 Depth To Water (DTW)

  • Enter Culianary Well #3 Total Flow

  • Enter Start Time

  • Is Curtis Spring Area Area Clean?

  • Enter Curtis Spring Discharge Flow

  • Enter Curtis Spring Total Flow

  • Enter Start Time

  • Are All Deep Well Booster Lights On In Pump Room?

  • Are All Deep Well Booster Lights On In MCC Room?

  • Is Deep Well Booster Pump Room Clean?

  • Is Deep Well Booster MCC Room Clean?

  • Enter Deep Well Discharge Flow

  • Enter Deep Well Discharge Pressure

  • Enter Deep Well Booster Sump Level

  • Are Any Pumps Running?

  • Choose Running Pump

  • Enter PP-01 Discharge Pressure

  • Enter PP-02 Discharge Pressure

  • Enter PP-03 Discharge Pressure

  • Enter PP-04 Discharge Pressure

  • Enter Start Time

  • Is H1 Box Area Clean?

  • Are Their Any Leak?

  • Enter Start Time

  • Is K-60 Well Pump Area Clean?

  • Is K-60 Well MCC Area Clean?

  • Are K-60 Well All Lights On In Pump Room?

  • Are K-60 Well All Lights On In MCC Room?

  • Enter K-60 Discharge Flow

  • Enter K-60 Total Flow

  • Enter K-60 Depth To Water (DTW)

  • Enter PP-801 Discharge Pressure

  • Enter PP-802 Discharge Pressure

  • Enter PP-801/PP-802 Differential Pressure

  • Enter Start Time

  • Is K-109 Well Pump Area Clean?

  • Is K-109 Well MCC Area Clean?

  • Are K-109 Well All Lights On In MCC Room?

  • Are K-109 Well All Lights On In Pump Room?

  • Enter K-109 Well Discharge Flow

  • Enter K-109 Total Flow

  • Enter K-109 Depth To Water (DTW)

  • Enter PP-821 Discharge Pressure

  • Enter PP-822 Discharge Pressure

  • Enter PP-821/PP-822 Differential Pressure

  • Enter Start Time

  • Is Lark Chlorinator Shack Clean?

  • Is Lark Chlorinator Shack Ventilation Fan Working?

  • Is Lark Chlorinator Shack Lights Working?

  • Is Lark Chlorinator Shack UV Lamps All On?

  • Enter Start Time

  • Is Large Reservoir Pump Room Area Clean?

  • Is Large Reservoir MCC Room Area Clean?

  • Are Large Reservoir Pump Room Lights All On?

  • Are Large Reservoir MCC Room Lights All On?

  • Enter PP-19 Discharge Flow

  • Enter Start Time

  • Is Lower Canal Area Clean?

  • Enter Bingham Tunnel Flow

  • Enter Lower Canal Sump Level

  • Enter Start Time

  • Is Mid-Valley Shack Room Area Clean?

  • Are Their Any Leaks?

  • Are Mid-Valley Room Lights All On?

  • Are Mid-Valley Heater Working?

  • Enter Mid-Valley Discharge Flow

  • Enter Mid-Valley Discharge Pressure

  • Enter Start Time

  • Is Moly Area Clean?

  • Enter Moly Tank Level

  • Enter Start Time

  • Is Notch Box Area Clean?

  • Enter Start Time

  • Is Notch Pump House Pump Room Area Clean?

  • Is Notch Pump House MCC Room Area Clean?

  • Are Notch Pump House Pump Room Lights All On?

  • Are Notch Pump House MCC Room Lights All On?

  • Are Their Any Leaks?

  • Enter Notch Pump House Discharge Flow

  • Enter Notch Pump House Discharge Pressure

  • Enter Start Time

  • Is Picnic Flats Shack Room Area Clean?

  • Are Their Any Leaks?

  • Are Picnic Flats Room Lights All On?

  • Are Picnic Flats Heater Working?

  • Enter Picnic Flats Discharge Flow

  • Enter Picnic Flats Discharge Pressure

  • Enter Start Time

  • Is Sulfate #1 Pump Room Area Clean?

  • Is Sulfate #1 Pump Room Area Clean?

  • Are Sulfate #1 Pump Room Lights All On?

  • Are Sulfate #1 MCC Room Lights All On?

  • Are Their Any Leaks?

  • Are Sulfate #1 Flats Heater Working?

  • Enter Sulfate #1 Flats Discharge Flow

  • Enter Sulfate #1 PP-28 Discharge Pressure

  • Enter Sulfate #1 PP-29 Discharge Pressure

  • Enter Sulfate #1 PP-28/PP-29 Differential Pressure

  • Enter Start Time

  • Is Sulfate #2 MCC Room Area Clean?

  • Is Sulfate #2 Pump Room Area Clean?

  • Are Sulfate #2 Pump Room Lights All On?

  • Are Sulfate #2 MCC Room Lights All On?

  • Are Picnic Flats Heater Working?

  • Are Their Any Leaks?

  • Enter Sulfate #2 Discharge Flow

  • Enter Sulfate #2 Depth To Water (DTW)

  • Enter Sulfate #2 Total Flow

  • Enter Sulfate #2 PP-901 Discharge Pressure

  • Enter Sulfate #2 PP-902 Discharge Pressure

  • Enter Sulfate #2 PP-901/PP-902 Differntial Pressure

  • Enter Start Time

  • Are Their Any Leaks?

  • Enter Start Time

  • Is Tail Water Reservoir MCC Room Area Clean?

  • Is Tail Water Reservoir Pump Room Area Clean?

  • Are Tail Water Reservoir Pump Room Lights All On?

  • Are Tail Water Reservoir MCC Room Lights All On?

  • Are Tail Water Reservoir Heater Working?

  • Are Their Any Leaks?

  • Enter Tail Water Reservoir Discharge Flow

  • Enter Tail Water Reservoir Level

  • Enter Tail Water Reservoir Total Flow

  • Enter Start Time

  • Is Truck Shop Booster MCC Room Area Clean?

  • Is Truck Shop Booster Pump Room Area Clean?

  • Are Truck Shop Booster Pump Room Lights All On?

  • Are Truck Shop Booster MCC Room Lights All On?

  • Are Truck Shop BoosterHeater Working?

  • Are Their Any Leaks?

  • Enter Truck Shop Booster Discharge Flow

  • Enter Truck Shop Booster Sump Level

  • Enter Truck Shop Booster Total Flow

  • Enter Start Time

  • Is White Elephant MCC Room Area Clean?

  • Is White Elephant Pump Room Area Clean?

  • Are White Elephant Pump Room Lights All On?

  • Are White Elephant MCC Room Lights All On?

  • Are White Elephant Heater Working?

  • Are Their Any Leaks?

  • Enter White Elephant Discharge Flow

  • Enter White Elephant Total Flow

  • Enter White Elephant PP-23 Discharge Pressure

  • Enter White Elephant Inlete Pressure

  • Enter White Elephant PP-24 Discharge Pressure

  • Enter White Elephant pH Value

  • Enter Start Time

  • Are Waste Water Pump Staion All Lights On In Pump Room?

  • Are Waste Water Pump StaionAll Lights On In MCC Room?

  • Is Waste Water Pump Staion Pump Room Clean?

  • Is Waste Water Pump Staion MCC Room Clean?

  • Enter Waste Water Pump Staion Discharge Flow

  • Enter Waste Water Pump StaionDischarge Pressure

  • Enter Waste Water Pump Staion Diversion Box Sump Level

  • Are Any Pumps Running?

  • Choose Running Pump

  • Enter PP-01 Discharge Pressure

  • Enter PP-02 Discharge Pressure

  • Enter PP-03 Discharge Pressure

  • Enter PP-04 Discharge Pressure

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.