⬡ Water Filter & UV System
INSPECTION FORM | WATER ROOM | SINGLE UV FILTER SYSTEM
RETAIN COMPLETED FORMS FOR RECORDS
FORM REV: 1.0
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1 of 1
Inspection Info
Date of Inspection
*
Time of Inspection
*
Inspector Name
*
Pressure Readings
PSI In (psi)
*
INLET PRESSURE
PSI Out (psi)
*
OUTLET PRESSURE
Pressure Drop
PSI IN − PSI OUT
⚑
CARTRIDGE FLAG:
If PSI Out is below 15 psi → NEW CARTRIDGE NEEDED – Order and replace immediately
UV Indicator Light
GREEN
GOOD – No action needed
YELLOW
FAIL – Replace UV lamp now
OUT
CHECK POWER supply / breaker
UV Status / Action — Describe action taken based on UV reading above
Notes / Initial Actions Taken
Notes
Corrections — Complete only when UV = Yellow or Out
Corrections Made
Completed By
Date Completed
Sign-Off
Inspector Signature
Date
Supervisor Approval
Date
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PSI In
PSI Out
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UV Status
Action
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Inspection Info
Date of Inspection
Time of Inspection
Inspector Name
Pressure Readings
PSI In (psi)
INLET PRESSURE
PSI Out (psi)
OUTLET PRESSURE
Pressure Drop
PSI IN − PSI OUT
UV Indicator Light
GREEN
GOOD – No action needed
YELLOW
FAIL – Replace UV lamp now
OUT
CHECK POWER supply / breaker
UV Status / Action
Notes / Initial Actions Taken
Notes
Corrections
Corrections Made
Completed By
Date Completed
Sign-Off
Inspector Signature
Date
Supervisor Approval
Date
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