Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Has the K.I.C.K process been followed
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Is the site safe to access
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Site Security / Compound Condition
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Wet Well Condition
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Overview of site / Wet Well / Kiosk / Panel / Electricity Meter
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Pump Hours Run
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Meter Reading
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MPAN Number
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Photo Of Meter
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Chain Condition
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Pump Check
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Pipe work / Valve condition
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Check Guildrails
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Kiosk Condition
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Condition of Panel
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Check operation of auto control of equipment
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If auto control failed or inop please provide reasons below
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Is FOW on work required
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If Yes to FOW please provide detail below
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Has Site been returned to auto
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Comments and overall site condition
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Inspection completed by
