Appendix C - Sample Forms
Form 1 - AST Inspection Form
University of Massachusetts Boston
DIESEL P.M. RUN RECORD
DAY:_________________
DATE: ________________
BLDG. ________________ UNIT: ________________________
NAME:___________________________
FUEL LEVEL
FULL
LOW
ENGINE COOLANT LEVEL
FULL
LOW
BELTS
FULL
LOW
BLOCK HEATER
FULL
LOW
BATTERY CELL LEVEL
FULL
LOW
MANUAL NO LOAD TEST:______________
AUTO LOAD TEST:___________________
VOLTAGE OUTPUT:___________________
FREQUENCY:________________________
AMPS START:_______________________
AMPS STOP:_________________________
HOT OIL PRESSURE:__________________
HOT COOLANT TEMPERATURE:___________
CHECK IF APPLICABLE:
DIESEL STORAGE TANK
VISUAL OK ________________
DIESEL DAY STORAGE TANK
VISUAL OK ________________
WASTE OIL DRUM
CLOSED _____________(IF FULL MOVE TO 160 BUILDING)
CONDITIONS:
PROBLEMS:
Form 2 - Weekly Waste Oil Inspection Form
ENVIRONMENTAL HEALTH & SAFETY
INSPECTOR:____________________
DATE:__________________________
| LOCATION | CONTAINERS | CONDITION | AISLES | |||||
| CLOSED | OPEN | LABELED | DATE | GOOD | POOR | CLEAR | BLOCKED | |
| 090/LL | ||||||||
| 010/LL | ||||||||
| 080/05 | ||||||||
| 110/04 | ||||||||
| 020/LL | ||||||||
| 120/LL | ||||||||
| 160 Acc. Area | ||||||||
| 150 Maintenance Garage |
