NBN Facilities Maintenance Inspection

NBN Facilities Maintenance Inspection
Site*
Date/Time of Inspection*

DayMonthYearHourMinutesAM/PM Option
Inspector*
Email address*
Site Type*
Level / Area*
Note: For all areas, select 'Site'
Work Order Number*

Score	Definition
5	Exceeds requirements - Service delivery far exceeds SOW Requirements
4	Meets every requirement - Each and every SOW requirement has been met throughout the entire period
3	Meets most requirements - Audit findings indicate good compliance with Service Outcomes at the site
2	Improvement required - Service is only just aligned to the Service outcomes. Service is about to fail
1	No requirements met - The service has failed to meet the minimal requirements of the Service Outcomes

1. Electrical
1.1 General Electrical
1.1 Inspect all powerpoints, light switches, switchboards for damage*

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1.1 Image:

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1.1 Corrective Action and close out date
1.2 Test and Tag
1.2a Tags must be valid.*

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1.2a Corrective Action and close out date
1.2b Record last test date.*
DD/MM/YYYY
1.2c Record next due date.*
DD/MM/YYYY
1.3 General Lighting
1.3 Inspect all lights and document lamps requiring replacement.*

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1.3 Image

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1.3 Corrective Action and close out date
1.4 Emergency & Exit Sign
1.4a Is a hard copy of testing record available onsite? Inspect all exit signs and document lamps requiring replacement.*

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1.4a Corrective Action and close out date
1.4b Record Last Service Date*
DD/MM/YYYY If maintained by landlord, check with base building FM for last service date
1.5 RCD Testing
1.5a Is a hard copy of the test record available onsite?*

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1.5a Image

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1.5a Corrective Action and close out date
1.5b RCD Testing - Record last service date*
DD/MM/YYYY
1.6 Switchboard
1.6 Check switchboard cabinet. Inspect for cleanliness*

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1.6 Image

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1.6 Corrective Action and close out date
1.7 Lifts
1.7a Check lift operation and cleanliness*

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1.7a Corrective Action and close out date
1.7b Record last compliance date in lift car*
DD/MM/YYYY
1.7c Operate 'Emergency Call' button to verify operational function of emergency phone, and record result of verificcation*
1.8 Other Lifting appliances
1.8a Check and record any damage*

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1.8a Corrective Action and close out date
1.8b Record last service date
DD/MM/YYYY
1i. Other issues, comments
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1ii. Other issues, comments
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1iii. Other issues, comments
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2. Hydraulics
2.1 Roofs and Gutters
2.1 Visual check for any vegetation grown out from gutter*

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2.1 Image

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2.1 Corrective Action and close out date
2.2 Zip Hot Water Filter
2.2a Check filter under the sink for sticker indicating last service date*

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2.2a Corrective Action and close out date
2.2b Record last service date*
DD/MM/YYYY
2.3 Bathrooms and Toilets
2.3 Inspect all bowls, sinks*

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2.3 Corrective Action and close out date
2.4 Kitchens and Breakout Areas
2.4 Inspect for any water leakage*

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2.4 Corrective Action and close out date
2.5 Pits and Pumps
2.5 Visually inspect the overall condition of the pump and pit for any debris*

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2.5 Corrective Action and close out date
2.8 Roof Safety Systems
2.8a Check for onsite certification, last service date must be current*

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2.8a Corrective Action and close out date
2.8b Record last service date*
DD/MM/YYYY
2.9 Water meter reading*
If not applicable, please put N/A
2i. Other issues, comments
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2ii. Other issues, comments
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2iii. Other issues, comments
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3. Building Maintenance
3.1 Cupboards & doors - Inspect alignment*

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3.1 Image

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3.1 Corrective Action and close out date
3.2 Door furniture - Inspect operation*

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3.2 Corrective Action and close out date
3.3 Door closers - Inspect operation*

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3.3 Corrective Action and close out date
3.4 Walls & Partitions - Inspect for damage and cleanliness*

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3.4 Corrective Action and close out date
3.5 Fixtures & Fittings - Inspect for damage*

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3.5 Corrective Action and close out date
3.6 Furniture - Inspect all desks, chairs and tables for damage*

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3.6 Corrective Action and close out date
3.7 Windows & coverings - Check for any abnormal wear and tear*

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3.7 Corrective Action and close out date
3.8 Floor covering - check for any abnormal wear and tear*

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3.8 Corrective Action and close out date
3i. Other issues, comments
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3ii. Other issues, comments
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3iii. Other issues, comments
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4. Automatic Doors and Gates
4.1 Check operation of all Auto doors/ turn stiles*

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4.1 Image

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4.1 Corrective Action and close out date
4.2 Check operation of all Auto gates/ boom gates*

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4.2 Image

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4.2 Corrective Action and close out date
4.3 Check operation of all roller shutters/ roll fast doors*

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4.3 Image

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4.3 Corrective Action and close out date
4i. Other issues, comments
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4ii. Other issues, comments
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4iii. Other issues, comments
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5. Diesel Fuel Storage Tanks
5.1 Visually inspect the access point, pit observation wells, dipsticks etc for corrosion, damage or leakage*

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5.1 Image

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5.1 Corrective Action and close out date
5.2 Visually inspect the fuel dispenser pump covers, pumps, piping, filters, gauging, dial gauges, nozzles and hoses etc for corrosion, damage or leakage. Check service record onsite and assess the overall condition of the equipment*

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5.2 Corrective Action and close out date
5.3 Visually inspect above ground tank for sign of leakage, damage and corrosion*

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5.3 Corrective Action and close out date
5.4a Visually inspect associated fuel pump for leakage, damage and corrosion.*

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5.4a Corrective Action and close out date
5.4b Last service date for fuel pump. Check service report onsite for last service date*
DD/MM/YYYY
5.5a Fuel tank meter reading - BULK TANK A*
If not applicable, please put 0000
5.5b Fuel tank meter reading - BULK TANK B*
If not applicable, please put 0000
5i. Other issues, comments
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5ii. Other issues, comments
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6. Heating, Ventilation, and Air Conditioning
6.1 Centralised System
6.1a Check for any water leakage from condensate drain, look for water stain marks on ceiling tiles. Check filter conditions if accessible.*

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6.1a Image

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6.1a Corrective Action and close out date
6.1b Check service report onsite and record last service date*
DD/MM/YYYY
6.2 Ducted Split System
6.2a Check for any water leakage from condensate drain, look for water stain marks on ceiling tiles. Check filter conditions if accessible.*

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6.2a Corrective Action and close out date
6.2b Check service report onsite and record last service date*
DD/MM/YYYY
6.3 Split System
6.3a If access is available, check outdoor unit for any blockage on condenser coil/fins. Check indoor unit location for any water stain mark on ceiling tiles for possible water leakage from condensate drain.*

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6.3a Image

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6.3a Corrective Action and close out date
6.3b Check service report onsite and record last service date*
DD/MM/YYYY
6.4 CRAC System
6.4a If access is available, check outdoor unit for any blockage on condenser coil/fins. Lift up raised floor tile and sample check for any water leakage under CRAC unit.*

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6.4a Corrective Action and close out date
6.4b Check service report onsite and record last service date*
DD/MM/YYYY
6.5 Mechanical Services Switchboard
6.5 Visual check on mechanical services switchboard for any alarm or warning light*

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6.5 Image

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6.5 Corrective Action and close out date
6.6 Thermostat
6.6 Visual check control thermostat for any dislocation or obstruction by other fixtures*

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6.6 Image

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6.6 Corrective Action and close out date
6i. Other issues, comments
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6ii. Other issues, comments
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6iii. Other issues, comments
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7. Fire Services
7.1 Fire Indicating Panel
7.1a Check tag current, check for damage, document defects. Check for appropriate signage including fire protection zones*

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7.1a Image

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7.1a Corrective Action and close out date
7.1b Check service report onsite and record last service date*
MM/YYYY
7.2 Sprinkler System
7.2a Check for any water dripping from any sprinkler head*

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7.2a Corrective Action and close out date
7.3 Fire Hydrant
7.3a Check tag current, check for damage, document defects. Check for appropriate signage*

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7.3a Corrective Action and close out date
7.3b Check service report onsite and record last service date*
MM/YYYY
7.4 Fire Hydrant Pump
7.4a Check tag current, check for damage, document defects. Check for appropriate signage*

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7.4a Corrective Action and close out date
7.4b Check service report onsite and record last service date*
MM/YYYY
7.5 Fire Extinguishers
7.5a Check Anti Tamper Device intact. Check tag current, check for damage, document defects. Check for appropriate signage*

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7.5a Corrective Action and close out date
7.5b Check service report onsite and record last service date*
MM/YYYY
7.6 Hose Reels
7.6a Check tag current, check for damage to hose & nozzle, document defects. Check for appropriate signage*

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7.6a Corrective Action and close out date
7.6b Check service report onsite and record last service date*
MM/YYYY
7.7 Fire Doors
7.7a Check for any visible damage to doors and lockset/handles. Check for Fire Door Signage. Document any Defects*

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7.7a Corrective Action and close out date
7.8 Fire Blanket
7.8a Check tag current, check for damage, document defects. Check for appropriate signage*

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7.8a Corrective Action and close out date
7.8b Fire Blanket - Check service report onsite and record last service date*
MM/YYYY
7i. Other issues, comments
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7ii. Other issues, comments
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8. Generator
8.1 Visual check on control panel for warning light*

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8.1 Corrective Action and close out date
8.2a Visual check on generator unit for any sign of fuel and water leakage. Visual check starter battery terminals for any sign of corrosion.*

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8.2a Corrective Action and close out date
8.2b Record filter replacement date marked on oil filter casing*
DD/MM/YYYY
8.2c Check service record onsite and record last service date*
DD/MM/YYYY
8i. Other issues, comments
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8ii. Other issues, comments
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8iii. Other issues, comments
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9. Uninterruptible Power Supply
9.1 Check local display panel for any warning lights*

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9.1 Corrective Action and close out date
9.2 Check battery compartment if accessible, for any signs of leakage*

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9.2 Corrective Action and close out date
9.3 Check service report onsite and record last service date for UPS*
DD/MM/YYYY
UPS and DC Power Load Reading
UPS Power Loading DB-A: L1*
UPS Power Loading DB-A: L2*
UPS Power Loading DB-A: L3*
UPS Power Loading DB-B: L1*
UPS Power Loading DB-B: L2*
UPS Power Loading DB-B: L3*
DC Power Loading LPS 1A*
DC Power Loading LPS 1B*
DC Power Loading LPS 2A*
DC Power Loading LPS 2B*
9i. Other issues, comments
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9ii. Other issues, comments
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Average:
1. Electrical
2. Hydraulics
3. Building Maintenance
4. Automatic Doors / Gates
5. Diesel Fuel Tanks
6. HVAC
7. Fire Services
8. Generator
9. UPS
TOTAL AVERAGE
Other comments:
Site Contact comments
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Work Order Audit
Work Order Number
Work is completed, compliant, and has been undertaken in a tradesman like and acceptable manner?

YesNo
Comments
Work Order Number
Work is completed, compliant, and has been undertaken in a tradesman like and acceptable manner?

YesNo
Comments
Work Order Number
Work is completed, compliant, and has been undertaken in a tradesman like and acceptable manner?

YesNo
Comments
Work Order Number
Work is completed, compliant, and has been undertaken in a tradesman like and acceptable manner?

YesNo
Comments
Work Order Number
Work is completed, compliant, and has been undertaken in a tradesman like and acceptable manner?

YesNo
Comments
FORM NBN-FM2 January 2015
Revision 1.0
Should be Empty:

NBN Facilities Maintenance Inspection

1. Electrical

2. Hydraulics

3. Building Maintenance

4. Automatic Doors and Gates

5. Diesel Fuel Storage Tanks

6. Heating, Ventilation, and Air Conditioning

7. Fire Services

8. Generator

9. Uninterruptible Power Supply