Title Page

  • Conducted on

  • Site of audit

  • Conducted by

  • Type of audit

Control Cubicle/Building

  • Lights in pump station working and in good condition

  • Doors and door seals in good working order

  • Cubicle fans and heaters in working order

  • Ventilation filters changed

  • Checked electrical connections throughout cubicle

UPS/Battery bank

  • RTU/PLC battery backup present

  • Battery in good condition (ie: no swelling,corrosion,leaking)

  • Charger/power supply working

  • Battery passed load test

  • UPS present

  • UPS load tested ok?

  • UPS in good condition externally

Pumps & Motors

  • Pump 1 present

  • Equipment no.

  • Pump starts

  • Run hours

  • Pump current

  • Pump flow

  • Thermal overload working

  • Thermistors working

  • Seal failure working

  • Pump 2 present

  • Equipment no.

  • Pump starts

  • Run hours

  • Pump current

  • Pump flow

  • Thermal overload working

  • Thermistors working

  • Seal failure working

  • Pump 3 present

  • Equipment no.

  • Pump starts

  • Run hours

  • Pump current

  • Pump flow

  • Thermal overload working

  • Thermistors working

  • Seal failure working

  • Pump 4 present

  • Equipment no.

  • Pump starts

  • Run hours

  • Pump current

  • Pump flow

  • Thermal overload working

  • Thermistors working

  • Seal failure working

  • Sump pump present

  • Sump pump working correctly

Valves

  • Valve 1 present

  • Valve equipment no.

  • Valve in good working order

  • Battery changed

  • Oil changed/topped up

  • Valve 2 present

  • Valve equipment no.

  • Valve in good working order

  • Battery changed

  • Oil changed/topped up

  • Valve 3 present

  • Valve equipment no.

  • Valve in good working order

  • Battery changed

  • Oil changed/topped up

  • Valve 4 present

  • Valve equipment no.

  • Valve in good working order

  • Battery changed

  • Oil changed/topped up

  • Valve 5 present

  • Valve equipment no.

  • Valve in good working order

  • Battery changed

  • Oil changed/topped up

  • Valve 6 present

  • Valve equipment no.

  • Valve in good working order

  • Battery changed

  • Oil changed/topped up

  • Valve 7 present

  • Valve equipment no.

  • Valve in good working order

  • Battery changed

  • Oil changed/topped up

  • Valve 8 present

  • Valve equipment no.

  • Valve in good working order

  • Battery changed

  • Oil changed/topped up

  • Valve 9 present

  • Valve equipment no.

  • Valve in good working order

  • Battery changed

  • Oil changed/topped up

  • Valve 10 present

  • Valve equipment no.

  • Valve in good working order

  • Battery changed

  • Oil changed/topped up

Pump Station Structure

  • High and low level floats working correctly

  • Pump station external structure in good condition

  • Pump station external fencing in good condition

  • Any other issues or problems with sewage pump station

  • Add media

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.