SIGNALLING / ALARM AND

INTERLOCK SYSTEM INSPECTION

RECORD
Plant/Unit Name: DAP 107B System No.: Q35000XX-
System: Doc. Reference Q3500XX-DAP-COMM-089

Tag No.: Specification: PID No.:

Instrument Specified: Location: Manufacturer:
Serial Number: Instruction Manual: Model No.:

Function (tick the relevant function) Type (tick the relevant type)
(1) By Relays
(1) Alarm System (2) Interlocking System (2) Wired Logic
(3) PLC
(3) Sequential System (4) …………………………….
Reference Drawings:

Test of Instrument Installation Works Calibration Check of Instruments

Verified See Report No.: ……………………

See Report No.: Deficiency Report Written

“ Check List” Report written & verified

Operational Checking
Cause of Action of Bypass
Logic DCS First out Alarm & Timer
Interlock Interlock Switch Result
Number Indication Functionality Lighting Setting
(input) (output) Position

Deficiency Report Written (Yes/No)

Remarks:

TEST/INSPECTION CARRIED OUT AND TEST/INSPECTION

DESCRIPTION
APPROVED BY: JESA APPROVED BY: OCP
Signature
Name
Date