Oil Refinery Equipment Assessment Form
Use this form to assess refinery equipment condition, safety, and maintenance needs during inspection.
Equipment Identification
Equipment Tag / Asset ID
*
Equipment Name
*
Refinery Unit / Area
*
Please Select
Crude Distillation Unit
Vacuum Distillation Unit
Hydrotreater
Catalytic Cracker
Reformer
Utilities
Tank Farm
Loading / Offloading
Other
Equipment Type / Category
*
Pump
Compressor
Heat Exchanger
Tank
Valve
Pipeline
Furnace
Reactor
Instrument
Other
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector Name or Team
*
Assessment and Condition Review
Current Operating Status
*
In Service
Standby
Out of Service
Under Repair
Overall Condition Rating
*
1
2
3
4
5
Mechanical Integrity Condition
*
Poor
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Poor, 10 is Excellent
Visible Corrosion or Damage
*
None Observed
Minor
Moderate
Severe
Leaks Present
*
Yes
No
Vibration or Noise Observed
*
Yes
No
Temperature Abnormality Observed
*
Yes
No
Safety Device Status
*
Satisfactory
Needs Attention
Not Installed
Not Inspected
Cleanliness and Housekeeping Condition
*
Poor
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Poor, 10 is Excellent
Inspection Findings and Maintenance Needs
Inspection findings by component
*
Rows
Condition
Status
Seals
1
2
Bearings
3
4
Valves
5
6
Pipes
7
8
Gauges
9
10
Insulation
11
12
Supports
13
14
Wiring / Instrumentation
15
16
Access / Guards
17
18
Defects and observations
Maintenance history / last service date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Priority / urgency of required action
*
Please Select
Immediate
High
Medium
Low
Monitor
Recommended corrective actions
Follow-up responsible party / department
Submit Assessment
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