Title Page

  • Client / Site:

  • Survey on:

  • Prepared by:

VDAR - WS

  • Cluster Name - Facilities Manager - Support FM / ID - Address:

  • Asset (1) Name:

  • Quantity

  • Quantity:

  • Last Service Date:

  • Asset System:

  • Asset Tag:

  • SFG20 Code:

  • Floor:

  • Floor:

  • Is asset Internal or External?

  • Location (Plant room name):

  • Manufacturer:

  • Model/Type:

  • Serial Number:

  • CONDITION REPORT

  • Is the plant accessible?

  • Comment for accessibility:

  • Are Controls operating

  • Comment for controls operating:

  • Is the Environment suitable for the plant ?

  • Comment for environment suitability:

  • Are there signs of damage ?

  • Comment for signs of damage:

  • Any health and safety concerns ?

  • Comment for any health and safety concerns:

  • Adequate means of isolation?

  • Comment for adequate means of isolation:

  • Condition Grade

  • Priority Grade

  • Estimated cost repair:

  • Included in contract Scope?

  • Included in Comp Liability?

  • Comments:

  • Photo of Asset name plate details

  • Photo of Asset Unit

  • Do you wish to add another Asset (2)?

  • Asset (2) Name:

  • Quantity

  • Quantity:

  • Last Service Date:

  • Asset System:

  • Asset Tag:

  • SFG20 Code:

  • Floor:

  • Floor:

  • Is asset Internal or External?

  • Location (Plant room name):

  • Manufacturer:

  • Model/Type:

  • Serial Number:

  • CONDITION REPORT

  • Is the plant accessible?

  • Comment for accessibility:

  • Are Controls operating

  • Comment for controls operating:

  • Is the Environment suitable for the plant ?

  • Comment for environment suitability:

  • Are there signs of damage ?

  • Comment for signs of damage:

  • Any health and safety concerns ?

  • Comment for any health and safety concerns:

  • Adequate means of isolation?

  • Comment for adequate means of isolation:

  • Condition Grade

  • Priority Grade

  • Estimated cost repair:

  • Included in contract Scope?

  • Included in Comp Liability?

  • Comments:

  • Photo of Asset name plate details

  • Photo of Asset Unit

  • Do you wish to add another Asset (3)?

  • Asset (3) Name:

  • Quantity

  • Quantity:

  • Last Service Date:

  • Asset System:

  • Asset Tag:

  • SFG20 Code:

  • Floor:

  • Floor:

  • Is asset Internal or External?

  • Location (Plant room name):

  • Manufacturer:

  • Model/Type:

  • Serial Number:

  • CONDITION REPORT

  • Is the plant accessible?

  • Comment for accessibility:

  • Are Controls operating

  • Comment for controls operating:

  • Is the Environment suitable for the plant ?

  • Comment for environment suitability:

  • Are there signs of damage ?

  • Comment for signs of damage:

  • Any health and safety concerns ?

  • Comment for any health and safety concerns:

  • Adequate means of isolation?

  • Comment for adequate means of isolation:

  • Condition Grade

  • Priority Grade

  • Estimated cost repair:

  • Included in contract Scope?

  • Included in Comp Liability?

  • Comments:

  • Photo of Asset name plate details

  • Photo of Asset Unit

  • Do you wish to add another Asset (4)?

  • Asset (4) Name:

  • Quantity

  • Quantity:

  • Last Service Date:

  • Asset System:

  • Asset Tag:

  • SFG20 Code:

  • Floor:

  • Floor:

  • Is asset Internal or External?

  • Location (Plant room name):

  • Manufacturer:

  • Model/Type:

  • Serial Number:

  • CONDITION REPORT

  • Is the plant accessible?

  • Comment for accessibility:

  • Are Controls operating

  • Comment for controls operating:

  • Is the Environment suitable for the plant ?

  • Comment for environment suitability:

  • Are there signs of damage ?

  • Comment for signs of damage:

  • Any health and safety concerns ?

  • Comment for any health and safety concerns:

  • Adequate means of isolation?

  • Comment for adequate means of isolation:

  • Condition Grade

  • Priority Grade

  • Estimated cost repair:

  • Included in contract Scope?

  • Included in Comp Liability?

  • Comments:

  • Photo of Asset name plate details

  • Photo of Asset Unit

  • Do you wish to add another Asset (5)?

  • Asset (5) Name:

  • Quantity

  • Quantity:

  • Last Service Date:

  • Asset System:

  • Asset Tag:

  • SFG20 Code:

  • Floor:

  • Floor:

  • Is asset Internal or External?

  • Location (Plant room name):

  • Manufacturer:

  • Model/Type:

  • Serial Number:

  • CONDITION REPORT

  • Is the plant accessible?

  • Comment for accessibility:

  • Are Controls operating

  • Comment for controls operating:

  • Is the Environment suitable for the plant ?

  • Comment for environment suitability:

  • Are there signs of damage ?

  • Comment for signs of damage:

  • Any health and safety concerns ?

  • Comment for any health and safety concerns:

  • Adequate means of isolation?

  • Comment for adequate means of isolation:

  • Condition Grade

  • Priority Grade

  • Estimated cost repair:

  • Included in contract Scope?

  • Included in Comp Liability?

  • Comments:

  • Photo of Asset name plate details

  • Photo of Asset Unit

  • Do you wish to add another Asset (6)?

  • Asset (6) Name:

  • Quantity

  • Quantity:

  • Last Service Date:

  • Asset System:

  • Asset Tag:

  • SFG20 Code:

  • Floor:

  • Floor:

  • Is asset Internal or External?

  • Location (Plant room name):

  • Manufacturer:

  • Model/Type:

  • Serial Number:

  • CONDITION REPORT

  • Is the plant accessible?

  • Comment for accessibility:

  • Are Controls operating

  • Comment for controls operating:

  • Is the Environment suitable for the plant ?

  • Comment for environment suitability:

  • Are there signs of damage ?

  • Comment for signs of damage:

  • Any health and safety concerns ?

  • Comment for any health and safety concerns:

  • Adequate means of isolation?

  • Comment for adequate means of isolation:

  • Condition Grade

  • Priority Grade

  • Estimated cost repair:

  • Included in contract Scope?

  • Included in Comp Liability?

  • Comments:

  • Photo of Asset name plate details

  • Photo of Asset Unit

  • Do you wish to add another Asset (7)?

  • Asset (7) Name:

  • Quantity

  • Quantity:

  • Last Service Date:

  • Asset System:

  • Asset Tag:

  • SFG20 Code:

  • Floor:

  • Floor:

  • Is asset Internal or External?

  • Location (Plant room name):

  • Manufacturer:

  • Model/Type:

  • Serial Number:

  • CONDITION REPORT

  • Is the plant accessible?

  • Comment for accessibility:

  • Are Controls operating

  • Comment for controls operating:

  • Is the Environment suitable for the plant ?

  • Comment for environment suitability:

  • Are there signs of damage ?

  • Comment for signs of damage:

  • Any health and safety concerns ?

  • Comment for any health and safety concerns:

  • Adequate means of isolation?

  • Comment for adequate means of isolation:

  • Condition Grade

  • Priority Grade

  • Estimated cost repair:

  • Included in contract Scope?

  • Included in Comp Liability?

  • Comments:

  • Photo of Asset name plate details

  • Photo of Asset Unit

  • Do you wish to add another Asset (8)?

  • Asset (8) Name:

  • Quantity

  • Quantity:

  • Last Service Date:

  • Asset System:

  • Asset Tag:

  • SFG20 Code:

  • Floor:

  • Floor:

  • Is asset Internal or External?

  • Location (Plant room name):

  • Manufacturer:

  • Model/Type:

  • Serial Number:

  • CONDITION REPORT

  • Is the plant accessible?

  • Comment for accessibility:

  • Are Controls operating

  • Comment for controls operating:

  • Is the Environment suitable for the plant ?

  • Comment for environment suitability:

  • Are there signs of damage ?

  • Comment for signs of damage:

  • Any health and safety concerns ?

  • Comment for any health and safety concerns:

  • Adequate means of isolation?

  • Comment for adequate means of isolation:

  • Condition Grade

  • Priority Grade

  • Estimated cost repair:

  • Included in contract Scope?

  • Included in Comp Liability?

  • Comments:

  • Photo of Asset name plate details

  • Photo of Asset Unit

  • Do you wish to add another Asset (9)?

  • Asset (9) Name:

  • Quantity

  • Quantity:

  • Last Service Date:

  • Asset System:

  • Asset Tag:

  • SFG20 Code:

  • Floor:

  • Floor:

  • Is asset Internal or External?

  • Location (Plant room name):

  • Manufacturer:

  • Model/Type:

  • Serial Number:

  • CONDITION REPORT

  • Is the plant accessible?

  • Comment for accessibility:

  • Are Controls operating

  • Comment for controls operating:

  • Is the Environment suitable for the plant ?

  • Comment for environment suitability:

  • Are there signs of damage ?

  • Comment for signs of damage:

  • Any health and safety concerns ?

  • Comment for any health and safety concerns:

  • Adequate means of isolation?

  • Comment for adequate means of isolation:

  • Condition Grade

  • Priority Grade

  • Estimated cost repair:

  • Included in contract Scope?

  • Included in Comp Liability?

  • Comments:

  • Photo of Asset name plate details

  • Photo of Asset Unit

  • Do you wish to add another Asset (10)?

  • Asset (10) Name:

  • Quantity

  • Quantity:

  • Last Service Date:

  • Asset System:

  • Asset Tag:

  • SFG20 Code:

  • Floor:

  • Floor:

  • Is asset Internal or External?

  • Location (Plant room name):

  • Manufacturer:

  • Model/Type:

  • Serial Number:

  • CONDITION REPORT

  • Is the plant accessible?

  • Comment for accessibility:

  • Are Controls operating

  • Comment for controls operating:

  • Is the Environment suitable for the plant ?

  • Comment for environment suitability:

  • Are there signs of damage ?

  • Comment for signs of damage:

  • Any health and safety concerns ?

  • Comment for any health and safety concerns:

  • Adequate means of isolation?

  • Comment for adequate means of isolation:

  • Condition Grade

  • Priority Grade

  • Estimated cost repair:

  • Included in contract Scope?

  • Included in Comp Liability?

  • Comments:

  • Photo of Asset name plate details

  • Photo of Asset Unit

  • Do you wish to add another Asset (11)?

  • Asset (11) Name:

  • Quantity

  • Quantity:

  • Last Service Date:

  • Asset System:

  • Asset Tag:

  • SFG20 Code:

  • Floor:

  • Floor:

  • Is asset Internal or External?

  • Location (Plant room name):

  • Manufacturer:

  • Model/Type:

  • Serial Number:

  • CONDITION REPORT

  • Is the plant accessible?

  • Comment for accessibility:

  • Are Controls operating

  • Comment for controls operating:

  • Is the Environment suitable for the plant ?

  • Comment for environment suitability:

  • Are there signs of damage ?

  • Comment for signs of damage:

  • Any health and safety concerns ?

  • Comment for any health and safety concerns:

  • Adequate means of isolation?

  • Comment for adequate means of isolation:

  • Condition Grade

  • Priority Grade

  • Estimated cost repair:

  • Included in contract Scope?

  • Included in Comp Liability?

  • Comments:

  • Photo of Asset name plate details

  • Photo of Asset Unit

  • Do you wish to add another Asset (12)?

  • Asset (12) Name:

  • Quantity

  • Quantity:

  • Last Service Date:

  • Asset System:

  • Asset Tag:

  • SFG20 Code:

  • Floor:

  • Floor:

  • Is asset Internal or External?

  • Location (Plant room name):

  • Manufacturer:

  • Model/Type:

  • Serial Number:

  • CONDITION REPORT

  • Is the plant accessible?

  • Comment for accessibility:

  • Are Controls operating

  • Comment for controls operating:

  • Is the Environment suitable for the plant ?

  • Comment for environment suitability:

  • Are there signs of damage ?

  • Comment for signs of damage:

  • Any health and safety concerns ?

  • Comment for any health and safety concerns:

  • Adequate means of isolation?

  • Comment for adequate means of isolation:

  • Condition Grade

  • Priority Grade

  • Estimated cost repair:

  • Included in contract Scope?

  • Included in Comp Liability?

  • Comments:

  • Photo of Asset name plate details

  • Photo of Asset Unit

  • Do you wish to add another Asset (13)?

  • Asset (13) Name:

  • Quantity

  • Quantity:

  • Last Service Date:

  • Asset System:

  • Asset Tag:

  • SFG20 Code:

  • Floor:

  • Floor:

  • Is asset Internal or External?

  • Location (Plant room name):

  • Manufacturer:

  • Model/Type:

  • Serial Number:

  • CONDITION REPORT

  • Is the plant accessible?

  • Comment for accessibility:

  • Are Controls operating

  • Comment for controls operating:

  • Is the Environment suitable for the plant ?

  • Comment for environment suitability:

  • Are there signs of damage ?

  • Comment for signs of damage:

  • Any health and safety concerns ?

  • Comment for any health and safety concerns:

  • Adequate means of isolation?

  • Comment for adequate means of isolation:

  • Condition Grade

  • Priority Grade

  • Estimated cost repair:

  • Included in contract Scope?

  • Included in Comp Liability?

  • Comments:

  • Photo of Asset name plate details

  • Photo of Asset Unit

  • Do you wish to add another Asset (14)?

  • Asset (14) Name:

  • Quantity

  • Quantity:

  • Last Service Date:

  • Asset System:

  • Asset Tag:

  • SFG20 Code:

  • Floor:

  • Floor:

  • Is asset Internal or External?

  • Location (Plant room name):

  • Manufacturer:

  • Model/Type:

  • Serial Number:

  • CONDITION REPORT

  • Is the plant accessible?

  • Comment for accessibility:

  • Are Controls operating

  • Comment for controls operating:

  • Is the Environment suitable for the plant ?

  • Comment for environment suitability:

  • Are there signs of damage ?

  • Comment for signs of damage:

  • Any health and safety concerns ?

  • Comment for any health and safety concerns:

  • Adequate means of isolation?

  • Comment for adequate means of isolation:

  • Condition Grade

  • Priority Grade

  • Estimated cost repair:

  • Included in contract Scope?

  • Included in Comp Liability?

  • Comments:

  • Photo of Asset name plate details

  • Photo of Asset Unit

  • Do you wish to add another Asset (15)?

  • Asset (15) Name:

  • Quantity

  • Quantity:

  • Last Service Date:

  • Asset System:

  • Asset Tag:

  • SFG20 Code:

  • Floor:

  • Floor:

  • Is asset Internal or External?

  • Location (Plant room name):

  • Manufacturer:

  • Model/Type:

  • Serial Number:

  • CONDITION REPORT

  • Is the plant accessible?

  • Comment for accessibility:

  • Are Controls operating

  • Comment for controls operating:

  • Is the Environment suitable for the plant ?

  • Comment for environment suitability:

  • Are there signs of damage ?

  • Comment for signs of damage:

  • Any health and safety concerns ?

  • Comment for any health and safety concerns:

  • Adequate means of isolation?

  • Comment for adequate means of isolation:

  • Condition Grade

  • Priority Grade

  • Estimated cost repair:

  • Included in contract Scope?

  • Included in Comp Liability?

  • Comments:

  • Photo of Asset name plate details

  • Photo of Asset Unit

  • Do you wish to add another Asset (16)?

  • Asset (16) Name:

  • Quantity

  • Quantity:

  • Last Service Date:

  • Asset System:

  • Asset Tag:

  • SFG20 Code:

  • Floor:

  • Floor:

  • Is asset Internal or External?

  • Location (Plant room name):

  • Manufacturer:

  • Model/Type:

  • Serial Number:

  • CONDITION REPORT

  • Is the plant accessible?

  • Comment for accessibility:

  • Are Controls operating

  • Comment for controls operating:

  • Is the Environment suitable for the plant ?

  • Comment for environment suitability:

  • Are there signs of damage ?

  • Comment for signs of damage:

  • Any health and safety concerns ?

  • Comment for any health and safety concerns:

  • Adequate means of isolation?

  • Comment for adequate means of isolation:

  • Condition Grade

  • Priority Grade

  • Estimated cost repair:

  • Included in contract Scope?

  • Included in Comp Liability?

  • Comments:

  • Photo of Asset name plate details

  • Photo of Asset Unit

  • Do you wish to add another Asset (17)?

  • Asset (17) Name:

  • Quantity

  • Quantity:

  • Last Service Date:

  • Asset System:

  • Asset Tag:

  • SFG20 Code:

  • Floor:

  • Floor:

  • Is asset Internal or External?

  • Location (Plant room name):

  • Manufacturer:

  • Model/Type:

  • Serial Number:

  • CONDITION REPORT

  • Is the plant accessible?

  • Comment for accessibility:

  • Are Controls operating

  • Comment for controls operating:

  • Is the Environment suitable for the plant ?

  • Comment for environment suitability:

  • Are there signs of damage ?

  • Comment for signs of damage:

  • Any health and safety concerns ?

  • Comment for any health and safety concerns:

  • Adequate means of isolation?

  • Comment for adequate means of isolation:

  • Condition Grade

  • Priority Grade

  • Estimated cost repair:

  • Included in contract Scope?

  • Included in Comp Liability?

  • Comments:

  • Photo of Asset name plate details

  • Photo of Asset Unit

  • Do you wish to add another Asset (18)?

  • Asset (18) Name:

  • Quantity

  • Quantity:

  • Last Service Date:

  • Asset System:

  • Asset Tag:

  • SFG20 Code:

  • Floor:

  • Floor:

  • Is asset Internal or External?

  • Location (Plant room name):

  • Manufacturer:

  • Model/Type:

  • Serial Number:

  • CONDITION REPORT

  • Is the plant accessible?

  • Comment for accessibility:

  • Are Controls operating

  • Comment for controls operating:

  • Is the Environment suitable for the plant ?

  • Comment for environment suitability:

  • Are there signs of damage ?

  • Comment for signs of damage:

  • Any health and safety concerns ?

  • Comment for any health and safety concerns:

  • Adequate means of isolation?

  • Comment for adequate means of isolation:

  • Condition Grade

  • Priority Grade

  • Estimated cost repair:

  • Included in contract Scope?

  • Included in Comp Liability?

  • Comments:

  • Photo of Asset name plate details

  • Photo of Asset Unit

  • Do you wish to add another Asset (19)?

  • Asset (19) Name:

  • Quantity

  • Quantity:

  • Last Service Date:

  • Asset System:

  • Asset Tag:

  • SFG20 Code:

  • Floor:

  • Floor:

  • Is asset Internal or External?

  • Location (Plant room name):

  • Manufacturer:

  • Model/Type:

  • Serial Number:

  • CONDITION REPORT

  • Is the plant accessible?

  • Comment for accessibility:

  • Are Controls operating

  • Comment for controls operating:

  • Is the Environment suitable for the plant ?

  • Comment for environment suitability:

  • Are there signs of damage ?

  • Comment for signs of damage:

  • Any health and safety concerns ?

  • Comment for any health and safety concerns:

  • Adequate means of isolation?

  • Comment for adequate means of isolation:

  • Condition Grade

  • Priority Grade

  • Estimated cost repair:

  • Included in contract Scope?

  • Included in Comp Liability?

  • Comments:

  • Photo of Asset name plate details

  • Photo of Asset Unit

  • Do you wish to add another Asset (20)?

  • Asset (20) Name:

  • Quantity

  • Quantity:

  • Last Service Date:

  • Asset System:

  • Asset Tag:

  • SFG20 Code:

  • Floor:

  • Floor:

  • Is asset Internal or External?

  • Location (Plant room name):

  • Manufacturer:

  • Model/Type:

  • Serial Number:

  • CONDITION REPORT

  • Is the plant accessible?

  • Comment for accessibility:

  • Are Controls operating

  • Comment for controls operating:

  • Is the Environment suitable for the plant ?

  • Comment for environment suitability:

  • Are there signs of damage ?

  • Comment for signs of damage:

  • Any health and safety concerns ?

  • Comment for any health and safety concerns:

  • Adequate means of isolation?

  • Comment for adequate means of isolation:

  • Condition Grade

  • Priority Grade

  • Estimated cost repair:

  • Included in contract Scope?

  • Included in Comp Liability?

  • Comments:

  • Photo of Asset name plate details

  • Photo of Asset Unit

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.