Water Facility Weekly Operational & Safety Assessment

• Audit Title

• Document No.

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel attending the inspection

• Are the grounds maintained?

  compliant

  Non-Compliant

  Not Applicable

• Are the SDS manuals available and current?

  compliant

  Non-Compliant

  Not Applicable

• Is the Operators' Daily Log book current and detailed?

  compliant

  Non-Compliant

  Not Applicable

• Are operational and maintenance manuals available and current?

  compliant

  Non-Compliant

  Not Applicable

• Does the O&M include all water source sites and the associated sampling and monitoring plans?

  compliant

  Non-Compliant

  Not Applicable

• Independent regulation compliance review performed? Is the latest report findings on file and available?

  compliant

  Non-Compliant

  Not Applicable

• Fire extinguishers inspected and dated?

  compliant

  Non-Compliant

  Not Applicable

• Safety showers/eyewashes inspected and dated?

  compliant

  Non-Compliant

  Not Applicable

• Facility interior clean and tidy?

  compliant

  Non-Compliant

  Not Applicable

• All personal protective equipment properly stored and clean?

  compliant

  Non-Compliant

  Not Applicable

• Chemical feed systems fully functional and no apparent leakage?

  compliant

  Non-Compliant

  Not Applicable

• Are there any known violations of the New Jersey Safe Drinking Water Act Regulations?

  compliant

  Non-Compliant

  Not Applicable

• Are all systems and equipment functional?

  Yes

  No

  N/A

Signatures

• Assistant Water Plant Manager

  Sign

• Water Plant Manager

  Sign