Water Cistern Maintenance Checklist
Complete this checklist to document the inspection and maintenance of a water cistern.
Technician Name
*
First Name
Last Name
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Location of Cistern
*
Cistern Capacity (in liters)
Visual Inspection Results
*
No visible cracks or leaks
No signs of contamination
Access hatch secure
Overflow pipe clear
Other (please specify)
Water Quality Check
*
Clear and odorless
Cloudy
Odor detected
Other (please specify)
Cleaning Performed?
*
Yes
No
Observed Issues
Maintenance Actions Taken
*
Parts Replaced (if any)
Next Maintenance Due Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Technician Signature
*
Submit Checklist
Submit Checklist
Should be Empty: