Information

  • Document No.

  • Building

  • Plant Room No.

  • Conducted on

  • Inspected By

  • Location in Building

Plant Room

  • Add Plant room

  • Plant room
  • Which plant room is being inspected?

Plant Room

  • HAS THE LAST INSPECTION BEEN REVIEWED

  • Is this the first recorded audit / inspection?

  • Read last audit report to ensure any issues are reviewed for this audit

Access and Egress

  • Door secure from unauthorised access

  • Is there un-obstructed access to and from the plant room

Lighting condition?

  • Plant room lighting adequate

  • Emergency lighting in standby and healthy?

Plant room Housekeeping?

  • Plant room general tidiness?

  • Slips, trips or spills?

  • Provisions in place for rubbish storage?

Equipment General Condition

  • Any equipment leaking creating slip hazards?

  • If 'At Risk' is it contained?

  • Arrange for leak to be attended too and contained.

  • Any noise not normal for this equipment?

  • If 'Yes' can you identify the cause?

  • Contact manufacturer or service provider for advice and possible site visit. If necessary and safe to do so, isolate equipment to make safe.

  • Distribution boards locked and secure?

Signage and Health / Safety

  • Signs in place, clean and visible?

  • First Aid kits in place and stocked?

  • Eye wash stations in place and in date?

  • Safety showers if fitted operational?

Sub Contractors

  • Are there any other personnel working in the area?

  • Company Name

  • Are they working in a safe manner?

  • Contact permit issuer and inform them of hazardous working ethics.

  • Do they have a valid PTW?

  • Ask them to "stop working" and contact their customer for a PTW

  • Who is the permit issuer?

  • Is the permit valid and in date?

  • Sub Contractors Housekeeping

Cold Water Storage Tank Inspection

  • Internal temperature reading of cold water in tank at time of inspection

  • Does the temperature reading record fall outside the legal tolerance, greater than 2 degrees, less than 60 degrees?

  • External Photograph

Internal Tank Chamber Assessment

  • Is there evidence of algae within the tank, caused by an unsecured or missing tank lid, that has resulted in sunlight exposure to the water?

  • Is there evidence of scale, calcium carbonate deposits from the mains created by evaporation at the water line?

  • Is there evidence of sediment within the tank chamber?

  • Is there evidence of rust or corrosion in the tank?

  • Is there evidence of organic matter or biofilm, within the tank chamber and water?

  • Is there any evidence of water stagnation during the inspection?

  • Is there any evidence of flora growth within tank chamber?

  • Is there any presence of pest/insect ingress within tank chamber?

  • Is there evidence of any other debris within tank chamber?

External Condition of Cold Water Storage Tank

  • Is there evidence of structural deterioration to the tank base?

  • Is there evidence of physical defect to the water tank structure that is a risk? Such as warped or split tank frame

  • Is the tank cover fitted in a good structure condition?

  • Is the cold water storage tank adequately lagged?

  • Is the tank fitted with insect screened protection?

  • Is the water tank suitably ventilated?

  • Are all isolating valves functioning correctly?

Other checks

  • Have all trap seals been replenished?

  • Are all pressures in all systems within the design parameters?

Photo Evidence

  • Faulty or damaged Equipment

  • Equipment Faults
  • Manufacturer

  • Model

  • TAG No / Serial Number

  • Nature of fault or damage

  • Add media

  • Any Issues Requiring Specialist Contractors to Attend

  • Company Required?

  • Add signature here.

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.