PLC DISCRETE OUTPUT CHECKLIST Page 1 of 2

Project

Facility: Project Name:

Area : Bid Opportunity:

PLC

PLC ID: Description:

Rack: Slot:

Pass
Pt Tag Description State State Desc. PLC Output Field Device
(P/F)

Form F-PLC-DO-CHECKLIST Rev 00, Created by SNC-Lavalin Inc.

L:\40ENG\Clients\City of Winnipeg\Electrical\Forms\Instrumentation Forms\F-PLC-DO-CHECKLIST.doc
 PLC DISCRETE OUTPUT CHECKLIST Page 2 of 2

Comments:

Company Name Signature Date (yyyy/mm/dd)

Tested By

Witnessed By

Form F-PLC-DO-CHECKLIST Rev 00, Created by SNC-Lavalin Inc.

L:\40ENG\Clients\City of Winnipeg\Electrical\Forms\Instrumentation Forms\F-PLC-DO-CHECKLIST.doc
 INSTRUMENTATION SWITCH CHECKLIST Page 1 of 1

Project

Facility: Project Name:

Area : Bid Opportunity:

Instrument

Tag: Description:

Manufacturer: Model: Serial Number:

Inspection Checklist
Pass
No. Item to be Inspected Comments
(P/F)
1. Instrument type and class per P&ID and specification

2. Instrument tag(s) installed and correct

3. Installation of sensor complete and correct

4. Block and drain valves

5. Pneumatic / hydraulic tubing leak tested

6. Heat tracing / insulation / instrument housing

7. Wiring correct

8. Drawings marked up as-built

9. HMI Graphic symbol and tag correct

State Checklist
Pass
State State Desc PLC Input Local HMI SCADA Alarm
(P/F)
0 On Off
N/A
1 On Off

Calibration
Setpoint Trip Point Actual Trip Point Setpoint Actual Pass
Transition
(incl. units) (incl. units) Time Delay Time Delay (P/F)
0
1

1
0

Comments:

Company Name Signature Date (yyyy/mm/dd)

Tested By

Witnessed By

Form F-INST-SW-CHECKLIST Rev 00, Created by SNC-Lavalin Inc

Form F-LOOP-CHECKLIST Rev 00, Created by SNC-Lavalin Inc.
L:\40ENG\Clients\City of Winnipeg\Electrical\Forms\Instrumentation Forms\F-INST-SW-CHECKLIST.doc
 INSTRUMENTATION TRANSMITTER LOOP CHECKLIST Page 1 of 2

Project

Facility: Project Name:

Area : Bid Opportunity:

Instrument (Sensor / Element)

Tag: Description:

Manufacturer: Model: Serial Number:

Transmitter

Tag: Description:

Manufacturer: Model: Serial Number:

Design
Units: -
Range:
4-20 mA Modbus Other:
Output
0-10 V Ethernet IP

Inspection Checklist
Pass
No. Item to be Inspected Comments
(P/F)
1. Instrument type and class per P&ID and specification

2. Instrument tag(s) installed and correct

3. Installation of sensor complete and correct

4. Block and drain valves

5. Pneumatic / hydraulic tubing leak tested

6. Heat tracing / insulation / instrument housing

7. Impulse lines pressure tested

8. Wiring correct

9. Drawings marked up as-built

10. HMI Graphic symbol, tag and units correct

Form F-INST-TRANS-CHECKLIST Rev 00, Created by SNC-Lavalin Inc.

L:\40ENG\Clients\City of Winnipeg\Electrical\Forms\Instrumentation Forms\F-INST-TRANS-CHECKLIST.doc
 INSTRUMENTATION TRANSMITTER LOOP CHECKLIST Page 2 of 2

Signal Validation
Input Pass
Location Design Value Actual Value Error (%)
Signal (P/F)
Transmitter Display

Transmitter Output

Process Display

PLC

HMI

Transmitter Display

Transmitter Output

Process Display

PLC

HMI

Transmitter Display

Transmitter Output

Process Display

PLC

HMI

Notes:
1. Attach factory calbration forms for all instruments where provided and/or specified.
2. Provide instrument parameters for each parameter changed from the factory default.

Comments:

Company Name Signature Date (yyyy/mm/dd)

Tested By

Witnessed By

Form F-INST-TRANS-CHECKLIST Rev 00, Created by SNC-Lavalin Inc.

L:\40ENG\Clients\City of Winnipeg\Electrical\Forms\Instrumentation Forms\F-INST-TRANS-CHECKLIST.doc
 PLC DISCRETE INPUT CHECKLIST Page 1 of 2

Project

Facility: Project Name:

Area : Bid Opportunity:

PLC

PLC ID: Description:

Rack: Slot:

PLC Local Pass

Pt Tag Description State State Desc. SCADA Alarm
Input HMI (P/F)

0 On Off
N/A
1 On Off

0 On Off
N/A
1 On Off

0 On Off
N/A
1 On Off

0 On Off
N/A
1 On Off

0 On Off
N/A
1 On Off

0 On Off
N/A
1 On Off

0 On Off
N/A
1 On Off

0 On Off
N/A
1 On Off

0 On Off
N/A
1 On Off

0 On Off
N/A
1 On Off

0 On Off
N/A
1 On Off

0 On Off
N/A
1 On Off

Form F-PLC-DI-CHECKLIST Rev 00, Created by SNC-Lavalin Inc.

L:\40ENG\Clients\City of Winnipeg\Electrical\Forms\Instrumentation Forms\F-PLC-DI-CHECKLIST.doc
 PLC DISCRETE INPUT CHECKLIST Page 2 of 2

0 On Off
N/A
1 On Off

0 On Off
N/A
1 On Off

0 On Off
N/A
1 On Off

0 On Off
N/A
1 On Off

Comments:

Company Name Signature Date (yyyy/mm/dd)

Tested By

Witnessed By

Form F-PLC-DI-CHECKLIST Rev 00, Created by SNC-Lavalin Inc.

L:\40ENG\Clients\City of Winnipeg\Electrical\Forms\Instrumentation Forms\F-PLC-DI-CHECKLIST.doc