Title Page

  • Operator

  • Rig name and Number

  • Conducted on

  • Prepared by

  • Location


  • Asset Number. Provide Photo

  • Inspect Frame for cracks and broken Welds. Provide Photos

  • Inspect cabinet for dents, bent door, rust and open holes. Provide Photos

  • Does HMI have Window kit (door) Provide Photos

  • Visually inspect all receptacles. Provide Photos

  • Visually Inspect Power cable. Provide Photos

  • Visually Inspect all Cable glands. Provide Photos

  • Visually Inspect Door Latches. Provide Photos


  • LOTO VFD Panel if required. Provide Photos

  • Is VFD Grounded. Provide Photos

  • Open Door and Inspect inside door latch. Provide Photos

  • Inspect Piano Door Hinges.

  • Inspect door seal. Provide Photos

  • Inspect All Receptacles from inside panel, look for hot spots in wire and condition of plastic insert. Provide Photos

  • Remove 200amp.100amp, 60amp and 30amp plug from receptacle, inspect sleave, prongs and gasket. Provide Photos

  • Disassemble plugs from centrifuge and pump, inspect wire connection to prong. Provide Photos

  • Visually inspect wires for burnt marks and lose terminals. Provide Photos of inside Panel

  • Visually Inspect Communication cable

  • Above steps complete, close panel door and Remove LOTO

Function Test

  • Plug in Centrifuge, Pump and communication cable.

  • Power up Panel

  • Function Test Back drive, Main Drive and Pump Drive If applicable. Provide Photos

  • Function Test E Stop.

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.