WATER DISTRIBUTION SYSTEM INSPECTION LOG GROVE/SYSTEM ID DATE ANIMAL ACTIVITY □Acceptable □Acceptable □Acceptable □Acceptable Check exposed system components for risk □Unacceptable □Unacceptable □Unacceptable □Unacceptable factors and vulnerability to animals. ADJACENT LAND ACTIVITY □Acceptable □Acceptable □Acceptable □Acceptable Check exposed system components for risk factors and vulnerability to adjacent land □Unacceptable □Unacceptable □Unacceptable □Unacceptable activity. STORM RUN OFF □Acceptable □Acceptable □Acceptable □Acceptable Check exposed system components for risk □Unacceptable □Unacceptable □Unacceptable □Unacceptable factors and vulnerability to storm run-off. UNDERGROUND COMPONENTS □Acceptable □Acceptable □Acceptable □Acceptable Survey system and grove for signs of damaged underground components (such as □Unacceptable □Unacceptable □Unacceptable □Unacceptable erosion or patches of lush green grass.) CROSS CONNECTIONS Check system for unused or dead-end lines □Acceptable □Acceptable □Acceptable □Acceptable that haven’t been regularly flushed or □Unacceptable □Unacceptable □Unacceptable □Unacceptable connections that are connected to a contaminated source CORRECTIVE ACTIONS AND/OR PREVENTATIVE MEASURES TAKEN IF ANY AREAS ARE UNACCEPTABLE INSPECTED BY INSERT COMPANY NAME HERE
WATER DISTRIBUTION SYSTEM INSPECTION LOG GROVE/SYSTEM ID DATE ANIMAL ACTIVITY Check exposed system components for risk factors and vulnerability to animals. □Acceptable □Unacceptable □Acceptable □Unacceptable □Acceptable □Unacceptable □Acceptable □Unacceptable ADJACENT LAND ACTIVITY Check exposed system components for risk factors and vulnerability to adjacent land activity. □Acceptable □Unacceptable □Acceptable □Unacceptable □Acceptable □Unacceptable □Acceptable □Unacceptable STORM RUN OFF Check exposed system components for risk factors and vulnerability to storm run-off. □Acceptable □Unacceptable □Acceptable □Unacceptable □Acceptable □Unacceptable □Acceptable □Unacceptable UNDERGROUND COMPONENTS Survey system and grove for signs of damaged underground components (such as erosion or patches of lush green grass.) □Acceptable □Unacceptable □Acceptable □Unacceptable □Acceptable □Unacceptable □Acceptable □Unacceptable CROSS CONNECTIONS Check system for unused or dead-end lines that haven’t been regularly flushed or connections that are connected to a contaminated source □Acceptable □Unacceptable □Acceptable □Unacceptable □Acceptable □Unacceptable □Acceptable □Unacceptable CORRECTIVE ACTIONS AND/OR PREVENTATIVE MEASURES TAKEN IF ANY AREAS ARE UNACCEPTABLE INSPECTED BY INSERT COMPANY NAME HERE
Citrus-Grower-Food-Safety-Plan-Final-05-01-2012.docx