Site Evaluation

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Vertical alignment (LHA) (Transverse angle)

• LHA 1 (6 min) (2 min)

  Yes

  No

  N/A

• LHA 2 (6 min)(2 min)

  Yes

  No

  N/A

• LHA 3 (6 min)(2 min)

  Yes

  No

  N/A

• LHA 4 (6 min)(2 min)

  Yes

  No

  N/A

input Voltage (10 %)

• L1-N 120v

  Yes

  No

  N/A

• L2-N 120v

  Yes

  No

  N/A

• L1-L2 240v

  Yes

  No

  N/A

Lamp Current (6.2-6.6)(4.2-5.7)

• Channel 1 high

  Yes

  No

  N/A

• Channel 2 high

  Yes

  No

  N/A

• Channel 1 low

  Yes

  No

  N/A

• Channel 2 low

  Yes

  No

  N/A

Filters

• LHA 1

  Yes

  No

  N/A

• LHA 2

  Yes

  No

  N/A

• LHA 3

  Yes

  No

  N/A

• LHA 4

  Yes

  No

  N/A

Photoelectric Control (within one minute)

• High intensity

  Yes

  No

  N/A

• Low intensity

  Yes

  No

  N/A

Remote control

• Operational

  Yes

  No

  N/A

TRDR

• Yes

  Yes

  No

  N/A

• No explain

  Yes

  No

  N/A

Modifications

• Ok

  Yes

  No

  N/A

• No list missing mods

  Yes

  No

  N/A

Lamps operational

• A minimum of two lights on/box

  Yes

  No

  N/A

Tilt switch operation

• LHA 1 Upper limit 30 min to 60 min<br>Lower limit -15 min to -30 min

  Yes

  No

  N/A

• LHA2 Upper limit 30 min to 60 min<br>Lower limit -15 min to -30 min

  Yes

  No

  N/A

• LHA 3 Upper limit 30 min to 60 min<br>Lower limit -15 min to -30 min

  Yes

  No

  N/A

• LHA4 Upper limit 30 min to 60 min<br>Lower limit -15 min to -30 min

  Yes

  No

  N/A

TPRs

• List discrepancies

  Yes

  No

  N/A

Paint, Stencil, Grounding

• List discrepancies

  Yes

  No

  N/A