Wastewater Lift Station Operation and Maintenance Checklist Form
Complete this checklist to document the operation and maintenance status of the wastewater lift station.
Inspection Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Lift Station Identification
*
Operator Name
*
First Name
Last Name
Operating Status
*
Normal
Warning
Fault
Offline
Equipment Checks (Pumps, Motors, Floats)
*
Pumps operational
Motors running normally
Floats functioning
No unusual noise/vibration
Other
Alarm/Status Observations
Maintenance Tasks Completed
Cleaned wet well
Lubricated equipment
Checked electrical panels
Tested alarms
Other
Issues Found
Corrective Actions Taken
Next Scheduled Service Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Checklist
Should be Empty: