Title Page

  • Conducted on

  • Site of audit

  • Conducted by

  • Type of audit

Control Cubicle/building

  • Lights working and in good condition

  • Doors and door seals in good working order

  • Cubicle fans and heaters in working order

  • Ventilation filters changed

  • Checked electrical connections throughout control cubicle

UPS/Battery bank

  • RTU/PLC battery backup present

  • Battery in good condition (ie: no swelling,corrosion,leaking)

  • Charger/power supply working

  • Battery passed load test

  • UPS present

  • UPS load tested ok?

  • UPS in good condition externally

Pumps

  • Pump one present

  • Run hours

  • Starts

  • Pump current

  • Pump running smoothly (ie: no bearing noise)

  • Pump two present

  • Run hours

  • Starts

  • Pump current

  • Pump running smoothly (ie: no bearing noise)

  • Pump three present

  • Run hours

  • Starts

  • Pump current

  • Pump running smoothly (ie: no bearing noise)

  • Pumps greased where required

  • Ventilation fans present

  • Fans working and running smoothly

  • Sump pump present

  • Sump pump and floats working correctly

Water Pump Station Structure

  • Water Pump Station external structure in good condition

  • Water Pump Station external fencing in good condition

  • Any other issues or problems with Water Pump Station

  • Add media

Motorised valves

  • Valve 1 present

  • Valve equipment number

  • Is valve in good working order

  • Battery changed

  • Oil checked

  • Valve 2 present

  • Valve equipment number

  • Is valve in good working order

  • Battery changed

  • Oil checked

  • Valve 3 present

  • Valve equipment number

  • Is valve in good working order

  • Battery changed

  • Oil checked

  • Valve 4 present

  • Valve equipment number

  • Is valve in good working order

  • Battery changed

  • Oil checked

  • Valve 5 present

  • Valve equipment number

  • Is valve in good working order

  • Battery changed

  • Oil checked

  • Valve 6 present

  • Valve equipment number

  • Is valve in good working order

  • Battery changed

  • Oil checked

  • Valve 7 present

  • Valve equipment number

  • Is valve in good working order

  • Battery changed

  • Oil checked

  • Valve 8 present

  • Valve equipment number

  • Is valve in good working order

  • Battery changed

  • Oil checked

  • Valve 9 present

  • Valve equipment number

  • Is valve in good working order

  • Battery changed

  • Oil checked

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.