iq purified water
TRANSCRIPT
INSTALLATION QUALIFICATION PROTOCOL
For the
NEW PURIFIED WATER SYSTEM
Prepared by
____________________________________
TABLE OF CONTENTS 1.0 PURPOSE AND OBJECTIVE(S) .................................................................................................................................... 4
2.0 BACKGROUND .............................................................................................................................................................. 4
3.0 SCOPE ........................................................................................................................................................................... 4
4.0 REFERENCES ............................................................................................................................................................... 4
5.0 RESPONSABILITIES ...................................................................................................................................................... 5
5.1 Validation Specialist ................................................................................................................................................... 5
5.2 Quality Dept. ............................................................................................................................................................... 5
5.3 Facility Dept. ............................................................................................................................................................... 5
6.0 METHODOLOGY ............................................................................................................................................................ 6
6.1 Verification Data Sheet ............................................................................................................................................... 6
6.2 Deviation Report ......................................................................................................................................................... 6
6.3 Signature Log Sheet ................................................................................................................................................... 6
6.4 Test Instruments Calibration ....................................................................................................................................... 6
7.0 EQUIPMENT/PROCESS DESCRIPTION ....................................................................................................................... 7
7.1 Water Softener ........................................................................................................................................................... 7
7.2 Ozone Generator ........................................................................................................................................................ 7
7.3 Reverse Osmosis ....................................................................................................................................................... 7
7.4 Mixed Bed................................................................................................................................................................... 7
7.5 Ozone Destructor ....................................................................................................................................................... 7
7.6 De-gasifier .................................................................................................................................................................. 8
7.7 UV light ....................................................................................................................................................................... 8
7.8 Filter ........................................................................................................................................................................... 8
APPENDIX I: DEVIATION REPORT .......................................................................................................................................... 11
APPENDIX II: SIGNATURE IDENTIFICATION LOG SHEET .................................................................................................... 12
APPENDIX III: TESTING INSTRUMENTS LOG SHEET ........................................................................................................... 13
IQ-01 EQUIPMENT VERIFICATION .......................................................................................................................................... 15
IQ-02 DOCUMENT INVENTORY VERIFICATION .................................................................................................................... 37
IQ-03 DRAWING VERIFICATION .............................................................................................................................................. 56
IQ-04 SYSTEM DESIGN VERIFICATION .................................................................................................................................. 58
IQ-05 PLACEMENT VERIFICATION ......................................................................................................................................... 60
IQ-06 UTILITY VERIFICATION .................................................................................................................................................. 67
IQ-07 INSTRUMENTATION VERIFICATION ............................................................................................................................. 86
IQ-08 MAINTENANCE VERIFICATION ..................................................................................................................................... 88
IQ-09 SAFETY & ERGONOMICS VERIFICATION .................................................................................................................. 107
IQ-10 PROCEDURE VERIFICATION ...................................................................................................................................... 109
IQ CHECKLIST VERIFICATION .............................................................................................................................................. 127
REVISION HISTORY
Revision Description of change Date
1.0 PURPOSE AND OBJECTIVE(S) This protocol (___) intends to provide documented evidence that the new Purified Water System was installed according to manufacturer’s specifications and ___ ___ requirements.
This Installation Qualification will provide documented evidence that all key aspects of the Purified Water System equipment’s assembly and its auxiliary systems is as intended by manufacturer design and in accordance to ___’s requirements.
At the end of the execution activities, a final report will be developed with a summary of the executed tests results and the recommendation(s) necessary for the Installation Qualification.
Potential risks involved with the new Purified Water System installation when connected to the manufacturing processes has already being evaluated by Risk Assessment PLS 0410.
2.0 BACKGROUND In order to meet the new purified water utility demands at ___ I in ___ ___, ___ ___, a new purified water system was purchased to replace the existing system. It is expected that this new purified water system will increase the supply to up to 100 GPM. Additionally, it is intended to produce a water quality that meets or exceeds current Purified Water USP and EP standards.
3.0 SCOPE This protocol applies to the new equipment and auxiliary components that constitute the Purified Water System, installed at ___ in ___ ___, ___ ___
4.0 REFERENCES
• FDA’s Office of Regulatory Affairs: “Guide To Inspections of High Purity Water Systems”
5.0 RESPONSABILITIES 5.1 Validation Specialist
• Prepare the documents that are applicable to the Validation exercise • Coordinate efforts and resources, along with Facilities Dept., to perform the Validation
exercise • Execute and collect the verification data for the Validation protocol • Verify data against Acceptance Criteria and initiate deviation, as applicable • Investigate, justify, and correct any deviation encountered during Validation execution • Prepare validation Final Report
5.2 Quality Dept. • Evaluate with the originator the extent of the validation required • Review and approve documents for the validation exercise • Review and approve validation activities for compliance and adherence to ___’s policies,
practices, and procedures • Check that the collected data meets the acceptance criteria and that all the deviations (if
applicable) are properly resolved • Once executed, review any deviations generated to confirm that investigation and
resolutions are complete • Cooperate with Validation Specialist to investigate, justify, and correct any deviation
encountered during Validation execution • Review and approve Final Report • Maintain original validation documentation, except for drawings and equipment manuals
that will remain in the equipment information files • Store the Validation Package in a designated filing area
5.3 Facility Dept. • Review and approve documents for the validation exercise • Coordinate efforts and resources to perform the validation activities • Supply documentation and tools needed for the protocol execution • Provide training in this protocol to all employees involved (internal and external) during the
execution of this protocol and ensure that all signatures are collected on Signature Log Sheet
• Assist to document, investigate, justify, and correct any deviation encountered during the IQ protocol execution
• Review and approve validation Final Report • Provide technical support for trouble shooting during the execution
6.0 METHODOLOGY 6.1 Verification Data Sheet
All data resulting from test execution will be entered in Verification Data Sheets that will pre-define the objective(s) to be attained with the verification, the procedure that will be followed to reach such objective(s), the reference material to be used, and the criteria to evaluate as to accept or not the testing results. All data entry will be properly signed and dated by the executor in the “Performed By” and “Date” spaces. In cases where a Field Verification is requested, a “Fail” condition will be applied to unverifiable information. The comments/observations section included in each Data Collection Form will be used to describe any additional information considered of importance for describing the validated condition and/or discrepancies and resolution activities produced during the execution. The comments/observations included must be signed or initialed and dated. When the test execution is finished, a subject matter expert will sign and date on the “Reviewed by” and “Date” spaces respectively, to state the completeness and correctness of the data.
6.2 Deviation Report The following deviations must be documented using the Deviation Report Form attached to this protocol: • Results invalidated and/or not in compliance with their pre-established Acceptance Criteria • Testing procedure and/or sampling plan not followed or that could not be completed as
planned These deviations will be handled as per ___ ___ PR
The investigation process due to deviated sampling results will be handled by contract laboratory, following their own investigation procedures. These incidents will be informed to who oversees the validation project in ___ ___, ___ PR, which in turn will open a deviation report to follow the lifecycle of the investigation and to implement any possible changes due to investigation resolution. Typographic, text edit and syntax errors will be documented as such in the “Comments” section under the corresponding test script, and considered as a minor issue that may not invalidate a test or become cause for writing a deviation report. These will be explained in the Final Report.
6.3 Signature Log Sheet Each individual who signs or initials any page included in this protocol shall be identified using the Signature Log Sheet by type/printed name, full signature, written initials and department represented.
6.4 Test Instruments Calibration All testing equipment used during for the execution shall be currently calibrated with documented evidence of its “up to date” calibration status. Copies of the calibration certificates shall be attached to the protocol and referred to the applicable test script.
7.0 EQUIPMENT/PROCESS DESCRIPTION Purified Water▲ is water obtained by distillation, ion-exchange treatment, reverse osmosis, and other suitable processes. It is prepared from water complying with the regulations of U.S. Environmental Protection Agency (EPA) with respect to drinking water. It contains no added substances.
The Purified Water system includes the following equipment, along with associated components:
• 30 um filters (2) • 6, 000 and 8, 000 Gal. Tanks
• 1 um filters (4) • Distribution Pumps (4)
• 0.2 um filters (4) • Dual Reverse Osmosis unit
• Dual Softener unit • Dual Mix Bed unit
• Ozone Generator • UV lamps (4)
• Ozone Destructor • Degasification unit
• Microza filters (18)
7.1 Water Softener The Water Softener reduces the levels of calcium and other scale creating elements from the process stream. Water softeners also remove aluminum, copper and other trace metals. The removal process occurs by ion exchange. The softener vessel is filled with sodium form cation resin. The calcium, magnesium, barium, strontium, and other ions removed by the resin are replaced with sodium ions. The cation resin has a fixed capacity for ion removal and must be regenerated when that capacity has been exhausted.
7.2 Ozone Generator The Ozone Generator is employed to produce the Ozone used to sanitize the Softened Water that passes through to the 6,000 Gallon Tank.
7.3 Reverse Osmosis The Reverse Osmosis unit processes water by means of semi-permeable membranes, which allow pressurized water to freely pass through the membranes, but almost totally reject dissolved and suspended substances in the feed water.
7.4 Mixed Bed The Mixed Bed de-mineralizes water by using the ion exchange process. The influent water passes through a bed of Cation and Anion resin that are intimately mixed. The mixed bed configuration functions similarly to a two-bed configuration in regards to the ion exchange process; however, it is much more efficient and therefore produces water of much greater purity.
7.5 Ozone Destructor The Ozone Destructor employs ultraviolet light to reduce the ozone level to a safe preset level before exiting the skid to the Service Points of Use. Ozone reduction is done by breakage of the O3 bonds at the ultraviolet spectrum.
▲As per United States Pharmacopeia (USP) standards
7.6 De-gasifier De-gasifier membranes are employed to reduce the oxygen level of the water. Membrane contactors make it possible to transfer gas from an aqueous stream without dispersion. By virtue of surface tension, the water on one side of the membrane is exposed to the gas side of the membrane with no liquid transfer, providing a large surface area for gas/liquid contact and transfer. Dissolved O2 passes from the water surface into the gas side by diffusion and is swept out by a combined vacuum/air flow.
7.7 UV lights Ultraviolet lamps produce UV-C (germicidal UV), which is a radiation that when harmful microbes are exposed to the UV rays, scrambles the DNA structure of the organism, rendering it sterile and can no longer reproduce. Almost all of a UV lamp’s output is concentrated in the 254 nanometers (nm) region in order to take full advantage of the germicidal properties of this wavelength. The lamp is mounted such that water passing through a flow chamber is exposed to the UV-C light rays.
7.8 Filters At the first stage, the raw water enters a 30 µm pre-filter to trap any heavy sediment before it enters the softeners. The 1 µm filters will act as a resin trap and removes suspended from the softeners. The absolute 0.2 micron rated filters significantly enhances the water quality with its capacity to remove the majority of microorganisms. The Microza ultra filters that are at the end of the purified water system uses fiber hollow technology that will remove endotoxins and viruses.
7.9 Distribution Pumps Two pairs of distribution pumps will provide constant flow of the processed water throughout the Purified Water System pipelines. Although its functionality will not contribute directly to the processing of Purified Water, by providing a constant flow will indeed significantly reduce the chances of microbial growth due to stagnant water.
7.10 Tanks Two storage tanks will provide storage capacity to the Purified Water System. A 6,000 gallon tank will store ozone-treated softened water that will supply constant feed to the dual R.O. unit, while an 8,000 gallon tank will store water post reverse osmosis and de-ozonization treatment, which will supply constant feed to the main loop.
With this configuration in place, a Purified Water (USP, EP) quality is intended to be achieved through the following processes: • Filtration (by means of 30 um filters, 1 um filters, 0.2 um filters, and R.O. Unit, and “Microza” filters) • Ion exchange (by means of Softener and Mix Bed) • Sanitation (by means of Ozone Injection and UV light radiation) • Degasification (by means of a de-gasifier unit)
APPENDICES
DEVIATION DESCRIPTION
Deviation reported by:_________________________________ Date: _________________
ENGINEERING INVESTIGATION
Attach additional pages, if necessary Root Cause: □Manpower □Methods □Equipment □ Materials □Environment
CORRECTIVE / PREVENTIVE ACTION
Evaluation performed by:____________________________________ Date: _________________ Testing required after Corrective action implemented? (YES/NO) ______________ Test results (PASS/FAIL/NA) ________________ Performed by: _______________________________________ Date: _______________________ Comments:
Reviewed by ______________________________________ Date: ____________________________
APPENDIX I: DEVIATION REPORT
Deviation Number: _________________
Test Description/Test Number:
Deviation Area: □ I/Q □ O/Q □ P/Q
APPENDIX II: SIGNATURE IDENTIFICATION LOG SHEET
This sheet is intended to record each individual who takes part of the execution process and is not included in the front page. The scope of this sheet applies to anyone who signs or initials any page included in the attached qualification documents. Each person shall be identified by typed or printed name, full signature, written initials, and department represented.
NAME SIGNATURE INITIALS DEPARTMENT
APPENDIX III: TESTING INSTRUMENTS LOG SHEET
This sheet is intended to record all field test instrument that assists in the execution process.
INSTRUMENT ID DESCRIPTION TEST ID CALIBRATION DATE/DUE DATE
COPY OF CERTIFICATE ATTACHED?
(YES/NO)
PERFORMED BY/DATE
VERIFICATION DATA SHEETS INSTALLATION QUALIFICATION
MAIN COMPONENT VERIFICATION IQ-01 Objective:
• Assure that all main and auxiliary components of the Purified Water System are as per manufacturer/vendor specifications (Manuals, Spec sheets, P & ID’s, etc.)
Pr
a. Per equipment, collect and document the required information thru physical inspection (tag, engrave, plate, sticker, etc)
ocedure:
b. Evaluate findings against specifications
References Required:
• Note: Vendor/Manufacturer documentation (Manuals, Spec sheets, P & ID’s, etc.) does not count as “Actual Result” reference
Acceptance Criteria:
• Actual results match expected results as per manufacturer written specifications
MAIN COMPONENT VERIFICATION IQ-01
Filter set 1A & 1B
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
1A
Tag ID
Cartridge Manufacturer
Cartridge Part No.
Housing Manufacturer
Housing Part No.
Quantity
1B
Tag ID
Cartridge Manufacturer
Cartridge Part No.
Housing Manufacturer
Housing Part No.
Quantity
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAIN COMPONENT VERIFICATION IQ-01
Filter set 2A & 2B
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
2A
Tag ID
Cartridge Manufacturer
Cartridge Part No.
Housing Manufacturer
Housing Part No.
Quantity
2B
Tag ID
Cartridge Manufacturer
Cartridge Part No.
Housing Manufacturer
Housing Part No.
Quantity
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAIN COMPONENT VERIFICATION IQ-01
Filter set 3A & 3B
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
3A
Tag ID
Cartridge Manufacturer
Cartridge Part No.
Housing Manufacturer
Housing Part No.
Quantity
3B
Tag ID
Cartridge Manufacturer
Cartridge Part No.
Housing Manufacturer
Housing Part No.
Quantity
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAIN COMPONENT VERIFICATION IQ-01
Filter set 4A & 4B
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
4A
Tag ID
Cartridge Manufacturer
Cartridge Part No.
Housing Manufacturer
Housing Part No.
Quantity
4B
Tag ID
Cartridge Manufacturer
Cartridge Part No.
Housing Manufacturer
Housing Part No.
Quantity
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAIN COMPONENT VERIFICATION IQ-01
Filter set 5A & 5 B
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
5A
Tag ID
Cartridge Manufacturer
Cartridge Part No.
Housing Manufacturer
Housing Part No.
Quantity
5B
Tag ID
Cartridge Manufacturer
Cartridge Part No.
Housing Manufacturer
Housing Part No.
Quantity
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAIN COMPONENT VERIFICATION IQ-01
Ozone Generator
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
Tag ID
Manufacturer
Model
Serial No.
Boo
ster
pum
p
Tag ID
Manufacturer
Model
Serial No.
Rec
ircul
atio
n pu
mp Tag ID
Manufacturer
Model
Serial No.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAIN COMPONENT VERIFICATION IQ-01
Ozone Destructor
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
Tag ID
Manufacturer
Model
Serial No.
UV
light
Tag ID
Manufacturer
Model
Serial No.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAIN COMPONENT VERIFICATION IQ-01
Dual Softener unit
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
Uni
t A
Tag ID
Manufacturer
Model
Serial No.
Uni
t B
Tag ID
Manufacturer
Model
Serial No.
Con
trol
Pan
el Manufacturer
Model
Res
in
Type
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAIN COMPONENT VERIFICATION IQ-01
Dual Softener unit (Brine Tank)
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
Tag ID
Manufacturer
Model
Serial No.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAIN COMPONENT VERIFICATION IQ-01
6,000 Gal. Tank
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
Tag ID
Manufacturer
Description
Vent
Filt
er
Cartridge Manufacturer
Cartridge Part No.
Housing Manufacturer
Housing Part No.
Leve
l Manufacturer
Part No.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAIN COMPONENT VERIFICATION IQ-01
Distribution Pumps (1A, 1B)
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
1A
Tag ID
Manufacturer
Model
Serial No.
2A
Tag ID
Manufacturer
Model
Serial No.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAIN COMPONENT VERIFICATION IQ-01
8,000 Gal. Tank
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
Tag ID
Manufacturer
Description
Vent
Filt
er
Cartridge Manufacturer
Cartridge Part No.
Housing Manufacturer
Housing Part No.
Leve
l Manufacturer
Part No.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAIN COMPONENT VERIFICATION IQ-01
Distribution Pumps (2A, 2B)
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
2A
Tag ID
Manufacturer
Model
Serial No.
2B
Tag ID
Manufacturer
Model
Serial No.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAIN COMPONENT VERIFICATION IQ-01
UV lamps (1A, 1B)
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
1A
Tag ID
Manufacturer
Model
Serial No.
1B
Tag ID
Manufacturer
Model
Serial No.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
EQUIPMENT VERIFICATION IQ-01
UV lamps (2A, 2B)
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
2A
Tag ID
Manufacturer
Model
Serial No.
2B
Tag ID
Manufacturer
Model
Serial No.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAIN COMPONENT VERIFICATION IQ-01
Dual Reverse Osmosis (Service unit A)
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
Tag ID
Manufacturer
Model
Serial No.
Feed
Pum
p
Tag ID
Manufacturer
Model
Serial No.
Ant
isca
lant
Dos
ing
Syst
em
Tag ID
Manufacturer
Model
Serial No.
Con
trol
Pan
el
Manufacturer
Model
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAIN COMPONENT VERIFICATION IQ-01
Dual Reverse Osmosis (Service unit B)
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
Tag ID
Manufacturer
Model
Serial No.
Feed
Pum
p
Tag ID
Manufacturer
Model
Serial No.
Ant
isca
lant
Dos
ing
Syst
em
Tag ID
Manufacturer
Model
Serial No.
Con
trol
Pan
el
Manufacturer
Model
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAIN COMPONENT VERIFICATION IQ-01
Dual R.O. unit (Cleaning Skid)
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
Tag ID
Manufacturer
Model
Serial No.
Cle
anin
g Pu
mp
Tag ID
Manufacturer
Model
Serial No.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAIN COMPONENT VERIFICATION IQ-01
De-gasification unit
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
Tag ID
Manufacturer
Model
Serial No.
Pum
p
Tag ID
Manufacturer
Model
Serial No.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAIN COMPONENT VERIFICATION IQ-01
Dual Mixed Bed unit
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
Uni
t A
Tag ID
Manufacturer
Model
Serial No.
Uni
t B
Tag ID
Manufacturer
Model
Serial No.
Con
trol
Pan
el Manufacturer
Model
Aci
d &
C
aust
ic
Type
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAIN COMPONENT VERIFICATION IQ-01
Microza “ultra filtration” filters
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
Tag ID
Manufacturer
Part No.
Serial No.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
DOCUMENT INVENTORY VERIFICATION IQ-02 Objective:
• Assure that all the basic literature required for the system operation/maintenance of the Purified Water system is available and properly stored
Pr
a. Per equipment, collect all related documentation
ocedure:
b. Document all relevant information according to “Document Info” column
c. If any of the “document type” is not applicable, write an Not Apply to the “Document Info”
column and explain in the “Comments/Observations” section References Required:
• Manufacturer’s Documentation - Installation and Operational Manuals, Wiring Diagrams, Spare Parts List, P & ID’s, etc.
• Vendor’s Documentation - Purchase Order, etc.
Acceptance Criteria:
• At least the basic literature (see document type) was found for all equipment and was found to be properly stored
• “Not applicable” document type was properly explained
DOCUMENT INVENTORY VERIFICATION IQ-02
Filter set 1A & 1B
DOCUMENT TYPE
DOCUMENT INFO (DOC #, TITLE, REV., LOCATION)
DOCUMENT STORAGE (LOCATION)
PERFORMED BY/DATE
Installation and Operation Manual
Purchase Order
Drawings
P & ID’s
Other Documents
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) ________ If NO, refer to Deviation # __________
Reviewed by: Date:
DOCUMENT INVENTORY VERIFICATION IQ-02
Filter set 2A & 2B
DOCUMENT TYPE
DOCUMENT INFO (DOC #, TITLE, REV., LOCATION)
DOCUMENT STORAGE (LOCATION)
PERFORMED BY/DATE
Installation and Operation Manual
Purchase Order
Drawings
P & ID’s
Other Documents
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) ________ If NO, refer to Deviation # __________
Reviewed by: Date:
DOCUMENT INVENTORY VERIFICATION IQ-02
Filter set 3A & 3B
DOCUMENT TYPE
DOCUMENT INFO (DOC #, TITLE, REV., LOCATION)
DOCUMENT STORAGE (LOCATION)
PERFORMED BY/DATE
Installation and Operation Manual
Purchase Order
Drawings
P & ID’s
Other Documents
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) ________ If NO, refer to Deviation # __________
Reviewed by: Date:
DOCUMENT INVENTORY VERIFICATION IQ-02
Filter set 3A & 3B
DOCUMENT TYPE
DOCUMENT INFO (DOC #, TITLE, REV., LOCATION)
DOCUMENT STORAGE (LOCATION)
PERFORMED BY/DATE
Installation and Operation Manual
Purchase Order
Drawings
P & ID’s
Other Documents
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) ________ If NO, refer to Deviation # __________
Reviewed by: Date:
DOCUMENT INVENTORY VERIFICATION IQ-02
Filter set 4A & 4B
DOCUMENT TYPE
DOCUMENT INFO (DOC #, TITLE, REV., LOCATION)
DOCUMENT STORAGE (LOCATION)
PERFORMED BY/DATE
Installation and Operation Manual
Purchase Order
Drawings
P & ID’s
Other Documents
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) ________ If NO, refer to Deviation # __________
Reviewed by: Date:
DOCUMENT INVENTORY VERIFICATION IQ-02
Filter set 5A & 5B
DOCUMENT TYPE
DOCUMENT INFO (DOC #, TITLE, REV., LOCATION)
DOCUMENT STORAGE (LOCATION)
PERFORMED BY/DATE
Installation and Operation Manual
Purchase Order
Drawings
P & ID’s
Other Documents
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) ________ If NO, refer to Deviation # __________
Reviewed by: Date:
DOCUMENT INVENTORY VERIFICATION IQ-02
Dual Softener unit
DOCUMENT TYPE
DOCUMENT INFO (DOC #, TITLE, REV., LOCATION)
DOCUMENT STORAGE (LOCATION)
PERFORMED BY/DATE
Installation and Operation Manual
Purchase Order
Electrical Drawings
Mechanical Drawings
P & ID’s
PLC Software Backup &
Report
MSDS
Other Documents
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) ________ If NO, refer to Deviation # __________
Reviewed by: Date:
DOCUMENT INVENTORY VERIFICATION IQ-02
6,000 Gal. Tank
DOCUMENT TYPE
DOCUMENT INFO (DOC #, TITLE, REV., LOCATION)
DOCUMENT STORAGE (LOCATION)
PERFORMED BY/DATE
Installation and Operation Manual
Purchase Order
Drawings
P & ID’s
Other Documents
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) ________ If NO, refer to Deviation # __________
Reviewed by: Date:
DOCUMENT INVENTORY VERIFICATION IQ-02
Distribution Pumps (1A, 1B)
DOCUMENT TYPE
DOCUMENT INFO (DOC #, TITLE, REV., LOCATION)
DOCUMENT STORAGE (LOCATION)
PERFORMED BY/DATE
Installation and Operation Manual
Purchase Order
Electrical Drawings
Mechanical Drawings
P & ID’s
Other Documents
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) ________ If NO, refer to Deviation # __________
Reviewed by: Date:
DOCUMENT INVENTORY VERIFICATION IQ-02
8,000 Gal. Tank
DOCUMENT TYPE
DOCUMENT INFO (DOC #, TITLE, REV., LOCATION)
DOCUMENT STORAGE (LOCATION)
PERFORMED BY/DATE
Installation and Operation Manual
Purchase Order
Drawings
P & ID’s
Other Documents
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) ________ If NO, refer to Deviation # __________
Reviewed by: Date:
DOCUMENT INVENTORY VERIFICATION IQ-02
Distribution Pumps (2A, 2B)
DOCUMENT TYPE
DOCUMENT INFO (DOC #, TITLE, REV., LOCATION)
DOCUMENT STORAGE (LOCATION)
PERFORMED BY/DATE
Installation and Operation Manual
Purchase Order
Electrical Drawings
Mechanical Drawings
P & ID’s
Other Documents
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) ________ If NO, refer to Deviation # __________
Reviewed by: Date:
DOCUMENT INVENTORY VERIFICATION IQ-02
Ozone Generator
DOCUMENT TYPE
DOCUMENT INFO (DOC #, TITLE, REV., LOCATION)
DOCUMENT STORAGE (LOCATION)
PERFORMED BY/DATE
Installation and Operation Manual
Purchase Order
Electrical Drawings
Mechanical Drawings
P & ID’s
PLC Software Backup &
Report
Other Documents
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) ________ If NO, refer to Deviation # __________
Reviewed by: Date:
DOCUMENT INVENTORY VERIFICATION IQ-02
Ozone Destructor
DOCUMENT TYPE
DOCUMENT INFO (DOC #, TITLE, REV., LOCATION)
DOCUMENT STORAGE (LOCATION)
PERFORMED BY/DATE
Installation and Operation Manual
Purchase Order
Electrical Drawings
P & ID’s
PLC Software Backup &
Report
Other Documents
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) ________ If NO, refer to Deviation # __________
Reviewed by: Date:
DOCUMENT INVENTORY VERIFICATION IQ-02
UV lamps (1A, 1B, 2A, 2B)
DOCUMENT TYPE
DOCUMENT INFO (DOC #, TITLE, REV., LOCATION)
DOCUMENT STORAGE (LOCATION)
PERFORMED BY/DATE
Installation and Operation Manual
Purchase Order
Electrical Drawings
P & ID’s
Other Documents
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) ________ If NO, refer to Deviation # __________
Reviewed by: Date:
DOCUMENT INVENTORY VERIFICATION IQ-02
Dual Reverse Osmosis unit
DOCUMENT TYPE
DOCUMENT INFO (DOC #, TITLE, REV., LOCATION)
DOCUMENT STORAGE (LOCATION)
PERFORMED BY/DATE
Installation and Operation Manual
Purchase Order
Electrical Drawings
Mechanical Drawing
P & ID’s
PLC Software Backup &
Report
MSDS
Other Documents
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) ________ If NO, refer to Deviation # __________
Reviewed by: Date:
DOCUMENT INVENTORY VERIFICATION IQ-02
Degasification unit
DOCUMENT TYPE
DOCUMENT INFO (DOC #, TITLE, REV., LOCATION)
DOCUMENT STORAGE (LOCATION)
PERFORMED BY/DATE
Installation and Operation Manual
Purchase Order
Electrical Drawings
Mechanical Drawings
P & ID’s
Other Documents
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) ________ If NO, refer to Deviation # __________
Reviewed by: Date:
DOCUMENT INVENTORY VERIFICATION IQ-02
Dual Mixed Bed unit
DOCUMENT TYPE
DOCUMENT INFO (DOC #, TITLE, REV., LOCATION)
DOCUMENT STORAGE (LOCATION)
PERFORMED BY/DATE
Installation and Operation Manual
Purchase Order
Electrical Drawings
P & ID’s
PLC Software Backup &
Report
Other Documents
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) ________ If NO, refer to Deviation # __________
Reviewed by: Date:
DOCUMENT INVENTORY VERIFICATION IQ-02
Microza “ultra filtration” filters
DOCUMENT TYPE
DOCUMENT INFO (DOC #, TITLE, REV., LOCATION)
DOCUMENT STORAGE (LOCATION)
PERFORMED BY/DATE
Installation and Operation Manual
Purchase Order
Electrical Drawings
P & ID’s
Other Documents
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) ________ If NO, refer to Deviation # __________
Reviewed by: Date:
DRAWING VERIFICATION IQ-03 Objective:
• Assure concordance between drawings (P & I D’s and Electrical Schematics, etc.) and field installation of the Purified Water System
Pr
a. Collect and document the drawings found thru IQ - 02: “Document Inventory Verification”
ocedure:
b. Verify against field installation by performing a physical inspection and redline drawings, if
discrepancy occurs
c. Sign, date & submit discrepancies to Facilities Dept. for review
d. Upon review, determine if drawings and/or field installation needs to be updated
e. Attach verified drawings to this protocol References Required:
• Process and Instrument Diagrams (P & I D’s)
• Electrical Schematics
Acceptance Criteria:
• Drawings match field installation and vice versa • Discrepancies between drawings and field installation were satisfactorily resolved by submitting
changes and updating drawings and/or field installation
DRAWING VERIFICATION IQ-03
Sheet ______ of ______
Use additional pages as necessary DRAWING TYPE & ID TITLE & REVISION REDLINED?
(YES/NO) UPDATE?
(DWG, FLD, NA) PERFORMED
BY/DATE
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
SYSTEM DESIGN VERIFICATION IQ-04 Objective:
• Assure that the installation design is in compliance with the specified requirements for systems capable of producing Purified Water
Pr
• Verify system installation as per specifications by performing a physical verification and/or providing documented evidence
ocedure:
• Document findings and evaluate against expected results
Note: This verification is best performed during “Drawing Verification”
References Required:
• P & ID’s • Material Safety Data Sheets • Chemical Analysis Sheets
Acceptance Criteria:
• Actual results match expected results as per Purified Water specifications
SYSTEM DESIGN VERIFICATION IQ-04
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
Feed water The raw water source supplied to the system must be from Well or City Water
Processing The system contains equipment capable of performing Deionization and Reverse Osmosis or Distillation.
Piping
Piping will provide constant circulation of Purified water.
Piping does not have an unused portion greater in length than six diameters of the unused pipe measured from the axis of the pipe in use (dead leg).
Contact material
All material in direct contact shall be non-reactive to Purified Water.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
PLACEMENT VERIFICATION IQ-05 Objective:
• Assure that the equipments have the appropriate conditions to perform setup and maintenance and to operate accordingly.
Pr
• Per equipment, verify field conditions by performing a physical inspection as per expected results
ocedure:
• Document and evaluate findings against expected results
References Required:
• Skid Drawings
Acceptance Criteria:
• Actual results match expected results as per ___ requirements
PLACEMENT VERIFICATION IQ-05
SKID #1 - Filter Set 1A, 1B
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
Position The equipment shall
be located along open type waste drains.
Environment The equipment is not
placed on direct sunlight or other sources of heat.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
PLACEMENT VERIFICATION IQ-05
SKID #2 - Filter set 2A, 2B
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
Position The equipment shall
be located along open type waste drains.
Environment The equipment is not
placed on direct sunlight or other sources of heat.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
PLACEMENT VERIFICATION IQ-05
SKID #3 - Distribution Pumps 1A, 1B; UV lamps 1A, 1B & Filter set 3A, 3B
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
Position The equipment shall
be located along open type waste drains.
Environment The equipment is not
placed on direct sunlight or other sources of heat.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
PLACEMENT VERIFICATION IQ-05
SKID #4 - R. O. Piping/Valves
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
Position The equipment shall
be located along open type waste drains.
Environment The equipment is not
placed on direct sunlight or other sources of heat.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
PLACEMENT VERIFICATION IQ-05
SKID 5 - Pumps 2A, 2B
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
Position The equipment shall
be located along open type waste drains.
Environment The equipment is not
placed on direct sunlight or other sources of heat.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
PLACEMENT VERIFICATION IQ-05
SKID 6 - UV lamps 2A, 2B & Filter 4A, 4B
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
Position The equipment shall
be located along open type waste drains.
Environment The equipment is not
placed on direct sunlight or other sources of heat.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
PLACEMENT VERIFICATION IQ-05
SKID 7 - Filter set 5A, 5B
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
Position The equipment shall
be located along open type waste drains.
Environment The equipment is not
placed on direct sunlight or other sources of heat.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
PLACEMENT VERIFICATION IQ-05
Water Softener Skid
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
Position The equipment shall
be located along open type waste drains.
Environment The equipment is not
placed on direct sunlight or other sources of heat.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
PLACEMENT VERIFICATION IQ-05
Ozone Generator Skid
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
Position The equipment shall
be located along open type waste drains.
Environment The equipment is not
placed on direct sunlight or other sources of heat.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
PLACEMENT VERIFICATION IQ-05
Ozone Destructor Skid
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
Position The equipment shall
be located along open type waste drains.
Environment The equipment is not
placed on direct sunlight or other sources of heat.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
PLACEMENT VERIFICATION IQ-05
R.O. Skid
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
Position The equipment shall
be located along open type waste drains.
Environment The equipment is not
placed on direct sunlight or other sources of heat.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
PLACEMENT VERIFICATION IQ-05
R.O. Cleaning Skid
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
Position The equipment shall
be located along open type waste drains.
Environment The equipment is not
placed on direct sunlight or other sources of heat.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
UTILITY VERIFICATION IQ-06 Objective:
• Assure that the installed utility meets the Purified Water System requirements
Pr
• Utility Verification
ocedure:
a. Per equipment, perform utility verification as per expected results by using a calibrated test
instrument (when required), and document results
b. Attach copy of instrument calibration certificate and ensure it is up to date
c. Ensure that each utility connection is properly labeled
• Electrical Verification
a. Perform verification as per Utility Verification thru a certified electrician
b. Attach copy of Electrician’s license and ensure it is up to date
Note: All readings will apply a ±10% tolerance References Required:
• Test Instruments calibration certificates
• Copy of Electrician’s license Acceptance Criteria:
• Utilities comply with expected results (manufacturer specifications)
• All calibrations/certifications are up to date
UTILITY VERIFICATION IQ-06
Dual Softener unit
ELECTRICAL SPECS EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
Voltage
Phase
Amperage
Frequency
Panel ID To be filled by a licensed electrician or electrical engineer with PE license Does electrical installation comply with NEC standards? (YES/NO) _______________
Electrician signature: ____________________________ License Number: ____________________________
OTHER SPECS EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
Compressed Air
Chemical
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
UTILITY VERIFICATION IQ-06
Ozone Generator
ELECTRICAL SPECS
EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
OZ-
1
Voltage Phase
Amperage Frequency Panel ID
P-O
Z1
Voltage Phase
Amperage Frequency Panel ID
P-O
Z2
Voltage Phase
Amperage Frequency Panel ID
Tran
sfor
mer
Voltage Phase
Amperage
Frequency
Panel ID To be filled by a licensed electrician or electrical engineer with PE license Does electrical installation comply with NEC standards? (YES/NO) _______________
Electrician signature: ___________________________ License Number: ___________________________
OTHER SPECS EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
Compressed Air 90-110 psig
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
UTILITY VERIFICATION IQ-06
Ozone Destructor
ELECTRICAL SPECS EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
Voltage
Phase
Amperage
Frequency
Panel ID
Bulb installation
To be filled by a licensed electrician or electrical engineer with PE license Does electrical installation comply with NEC standards? (YES/NO) _______________
Electrician signature: ____________________________ License Number: ____________________________
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
UTILITY VERIFICATION IQ-06
UV lamps (1A, 1B)
ELECTRICAL SPECS EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
Voltage
Phase
Amperage
Frequency
Panel ID
Bulb installation
To be filled by a licensed electrician or electrical engineer with PE license Does electrical installation comply with NEC standards? (YES/NO) _______________
Electrician signature: ____________________________ License Number: ____________________________ Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
UTILITY VERIFICATION IQ-06
UV lamps (2A, 2B)
ELECTRICAL SPECS EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
Voltage
Phase
Amperage
Frequency
Panel ID
Bulb installation
To be filled by a licensed electrician or electrical engineer with PE license Does electrical installation comply with NEC standards? (YES/NO) _______________
Electrician signature: ____________________________ License Number: ___________________________
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
UTILITY VERIFICATION IQ-06
Distribution Pumps (1A, 1B)
ELECTRICAL SPECS EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
Voltage
Phase
Amperage
Frequency
Panel ID
To be filled by a licensed electrician or electrical engineer with PE license Does electrical installation comply with NEC standards? (YES/NO) _______________
Electrician signature: ____________________________ License Number: ___________________________ Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
UTILITY VERIFICATION IQ-06
Distribution Pumps (2A, 2B)
ELECTRICAL SPECS EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
Voltage
Phase
Amperage
Frequency
Panel ID
To be filled by a licensed electrician or electrical engineer with PE license Does electrical installation comply with NEC standards? (YES/NO) _______________
Electrician signature: ____________________________ License Number: ___________________________ Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
UTILITY VERIFICATION IQ-06
Dual Reverse Osmosis unit
ELECTRICAL SPECS
EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
Uni
t A
Voltage1
Voltage2
Phase1
Phase2
Amperage1
Amperage2
Frequency
Panel ID
Uni
t B
Voltage1 Voltage2
Phase1 Phase2
Amperage1
Amperage2 Frequency Panel ID
To be filled by a licensed electrician or electrical engineer with PE license Does electrical installation comply with NEC standards? (YES/NO) _______________
Electrician signature: ____________________________ License Number: _____________________________
OTHER SPECS EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
Compressed Air 80-110 psig
Comments/Observations: 1Assembly power to assembly panel (PLC) 2Plant power to assembly power
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
UTILITY VERIFICATION IQ-06
Dual Reverse Osmosis unit (Cleaning Skid)
ELECTRICAL SPECS EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORME
D BY/DATE
Voltage
Phase
Amperage
Frequency
Panel ID To be filled by a licensed electrician or electrical engineer with PE license Does electrical installation comply with NEC standards? (YES/NO) _______________
Electrician signature: ____________________________ License Number: _________________________
OTHER SPECS EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
Chemicals
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
UTILITY VERIFICATION IQ-06
Dual Reverse Osmosis unit (pumps)
ELECTRICAL SPECS EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
R.O
Fee
d Pu
mp
Voltage
Phase
Amperage
Frequency
Panel ID
R.O
. Cle
anin
g Pu
mp
Voltage
Phase
Amperage
Frequency
Panel ID
AD
S Pu
mp
Voltage
Phase
Amperage
Frequency
Panel ID
To be filled by a licensed electrician or electrical engineer with PE license Does electrical installation comply with NEC standards? (YES/NO) _______________ Electrician signature: ____________________________ License Number: ____________________________ Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
UTILITY VERIFICATION IQ-06
Degasification unit
ELECTRICAL SPECS
EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
Deg
as P
anel
Voltage
Phase
Amperage
Frequency
Panel ID
Vacu
um P
ump
Voltage
Phase
Amperage
Frequency
Panel ID
To be filled by a licensed electrician or electrical engineer with PE license Does electrical installation comply with NEC standards? (YES/NO) _______________ Electrician signature: ___________________________ License Number: _____________________________
OTHER SPECS EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
Compressed Air
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
UTILITY VERIFICATION IQ-06
Dual Mixed Bed unit
ELECTRICAL SPECS EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
Voltage
Phase
Amperage
Frequency
Panel ID
To be filled by a licensed electrician or electrical engineer with PE license Does electrical installation comply with NEC standards? (YES/NO) _______________
Electrician signature: ___________________________ License Number: ____________________________
OTHER SPECS EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
Compressed Air (control panel)
Clean Compressed Air
(MB column)
Chemicals
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
INSTRUMENTATION VERIFICATION IQ-07 Objective:
• Assure that all the instrumentation installed in the Purified Water System that requires calibration are added to a calibration program
Pr
a. Inspect all instruments evaluated with the “Calibration Program Addition Form” and verify that all instruments installed at the Purified Water System were included
ocedure:
b. Record instruments (ID & type) that requires calibration according to the “Calibration Program
Addition Form”
c. Verify if the instrument that requires calibration is currently calibrated and record finding
d. Attach calibration certificate of all calibrated instruments References Required: Acceptance Criteria:
• Instruments that required calibration were included in site calibration program
• Instruments are currently calibrated
INSTRUMENTATION VERIFICATION IQ-07
Sheet ______ of ______ Use additional pages as necessary
INSTRUMENT ID INSTRUMENT TYPE
IT IS CURRENTLY CALIBRATED? (YES/NO/NA)
CALIBRATION DUE DATE
PERFORMED BY/DATE
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAINTENANCE VERIFICATION IQ-08 Objective:
• Assure that the Purified Water System is included in a Preventive Maintenance Program and a spare parts list exists
Pr
a. Per equipment, verify and document the required information by collecting documented evidence (i.e. PM checklist, PM schedule) of the inclusion of the Purified Water System components into ___’s Preventive Maintenance Program
ocedure:
b. Collect the Spare Parts list; verify & document the required information
c. Collect the Lubricants list; verify & document the required information
d. If lubricant specifications is not applicable, write a Not Apply to the “Actual Result” column and
explain in the “Comments/Observations” section
References Required:
• Evidence of PMP inclusion - PM checklist, PM schedule, PM program printouts, etc.
• Spare Parts list
• Lubricants list
• FOP 4.1 “Scheduled Preventive Maintenance” Acceptance Criteria:
• All equipment is included in a PM schedule
• All equipment has spare part list
• “Not applicable” lubricant requirements were properly explained
MAINTENANCE VERIFICATION IQ-08
Filter set 1A &1B
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
PMP
A PM checklist, schedule or similar is available as evidence of inclusion into the
PM program.
Spare Parts
Spare parts inventory is available for the
equipment.
Lubricants Lubricants inventory is
available for the equipment.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAINTENANCE VERIFICATION IQ-08
Filter set 2A & 2B
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
PMP
A PM checklist, schedule or similar is available as evidence of inclusion into the
PM program.
Spare Parts
Spare parts inventory is available for the
equipment.
Lubricants Lubricants inventory is
available for the equipment.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAINTENANCE VERIFICATION IQ-08
Filter set 3A & 3B
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
PMP
A PM checklist, schedule or similar is available as evidence of inclusion into the
PM program.
Spare Parts
Spare parts inventory is available for the
equipment.
Lubricants Lubricants inventory is
available for the equipment.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAINTENANCE VERIFICATION IQ-08
Filter set 4A & 4B
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
PMP
A PM checklist, schedule or similar is available as evidence of inclusion into the
PM program.
Spare Parts
Spare parts inventory is available for the
equipment.
Lubricants Lubricants inventory is
available for the equipment.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAINTENANCE VERIFICATION IQ-08
Filter set 5A & 5B
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
PMP
A PM checklist, schedule or similar is available as evidence of inclusion into the
PM program.
Spare Parts
Spare parts inventory is available for the
equipment.
Lubricants Lubricants inventory is
available for the equipment.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAINTENANCE VERIFICATION IQ-08
Dual Softener unit
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
PMP
A PM checklist, schedule or similar is available as evidence of inclusion into the
PM program.
Spare Parts
Spare parts inventory is available for the
equipment.
Lubricants Lubricants inventory is
available for the equipment.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAINTENANCE VERIFICATION IQ-08
Ozone Generator
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
PMP
A PM checklist, schedule or similar is available as evidence of inclusion into the
PM program.
Spare Parts
Spare parts inventory is available for the
equipment.
Lubricants Lubricants inventory is
available for the equipment.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAINTENANCE VERIFICATION IQ-08
Ozone Destructor
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
PMP
A PM checklist, schedule or similar is available as evidence of inclusion into the
PM program.
Spare Parts
Spare parts inventory is available for the
equipment.
Lubricants Lubricants inventory is
available for the equipment.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAINTENANCE VERIFICATION IQ-08
6,000 Gal. Tank
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
PMP
A PM checklist, schedule or similar is available as evidence of inclusion into the
PM program.
Spare Parts
Spare parts inventory is available for the
equipment.
Lubricants Lubricants inventory is
available for the equipment.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAINTENANCE VERIFICATION IQ-08
8,000 Gal. Tank
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
PMP
A PM checklist, schedule or similar is available as evidence of inclusion into the
PM program.
Spare Parts
Spare parts inventory is available for the
equipment.
Lubricants Lubricants inventory is
available for the equipment.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAINTENANCE VERIFICATION IQ-08
Distribution Pumps (1A, 1B)
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
PMP
A PM checklist, schedule or similar is available as evidence of inclusion into the
PM program.
Spare Parts
Spare parts inventory is available for the
equipment.
Lubricants Lubricants inventory is
available for the equipment.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAINTENANCE VERIFICATION IQ-08
Distribution Pumps (2A, 2B)
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
PMP
A PM checklist, schedule or similar is available as evidence of inclusion into the
PM program.
Spare Parts
Spare parts inventory is available for the
equipment.
Lubricants Lubricants inventory is
available for the equipment.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAINTENANCE VERIFICATION IQ-08
UV lamps (1A, 1B)
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
PMP
A PM checklist, schedule or similar is available as evidence of inclusion into the
PM program.
Spare Parts
Spare parts inventory is available for the
equipment.
Lubricants Lubricants inventory is
available for the equipment.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAINTENANCE VERIFICATION IQ-08
UV lamps (2A, 2B)
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
PMP
A PM checklist, schedule or similar is available as evidence of inclusion into the
PM program.
Spare Parts
Spare parts inventory is available for the
equipment.
Lubricants Lubricants inventory is
available for the equipment.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAINTENANCE VERIFICATION IQ-08
Dual Reverse Osmosis unit
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
PMP
A PM checklist, schedule or similar is available as evidence of inclusion into the
PM program.
Spare Parts
Spare parts inventory is available for the
equipment.
Lubricants Lubricants inventory is
available for the equipment.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAINTENANCE VERIFICATION IQ-08
De-gasification unit
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
PMP
A PM checklist, schedule or similar is available as evidence of inclusion into the
PM program.
Spare Parts
Spare parts inventory is available for the
equipment.
Lubricants Lubricants inventory is
available for the equipment.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAINTENANCE VERIFICATION IQ-08
Dual Mixed Bed unit
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
PMP
A PM checklist, schedule or similar is available as evidence of inclusion into the
PM program.
Spare Parts
Spare parts inventory is available for the
equipment.
Lubricants Lubricants inventory is
available for the equipment.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
MAINTENANCE VERIFICATION IQ-08
Microza “ultra filtration” filters
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED BY/DATE
PMP
A PM checklist, schedule or similar is available as evidence of inclusion into the
PM program.
Spare Parts
Spare parts inventory is available for the
equipment.
Lubricants Lubricants inventory is
available for the equipment.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
SAFETY & ERGONOMICS VERIFICATION IQ-09 Objective:
• Assure that the Purified Water System complies with ___’s EHS Safety and Ergonomics requirements
Pr
• Collect documented evidence (i.e. EHS checklist) of EHS evaluation of the Purified Water System
ocedure:
• Document evaluation results and compare against expected results
References Required:
• Evidence of EHS evaluation - EHS checklist, etc. Acceptance Criteria:
• EHS checklist is approved by EHS representative
SAFETY & ERGONOMICS VERIFICATION IQ-09
SPEC EXPECTED RESULT ACTUAL RESULT PASS/FAIL PERFORMED
BY/DATE
PWS Safety & Ergonomics Compliance
EHS Change Management AWO column checklist was completed and approved.
EHS found Purified Water System to be in compliance.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
PROCEDURE VERIFICATION IQ-10 Objective:
• Assure written procedures for the operation and maintenance of the Purified Water System Pr
a. Per equipment, collect and evaluate written procedures (i.e. operating, maintenance, cleaning) and document findings
ocedure:
b. If any of the specifications is not applicable, write a Not Apply to the “Actual Result” column and
explain in the “Comments/Observations” section
c. Evaluate findings against expected results References Required:
• SOP’s (at least in DRAFT form) Acceptance Criteria:
• Draft procedures are available for each main component of the Purified Water System.
PROCEDURE VERIFICATION IQ-10
Filter set 1A & 1B
SOP EXPECTED RESULT
ACTUAL RESULT (DOC. NO., REV. NO., TITLE, STATUS) PASS/FAIL PERFORMED
BY/DATE
Operating Procedure
A procedure exists at least in
Draft form.
Maintenance Procedure
A procedure exists at least in
Draft form.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
PROCEDURE VERIFICATION IQ-10
Filter 2A & 2B
SOP EXPECTED RESULT
ACTUAL RESULT (DOC. NO., REV. NO., TITLE, STATUS) PASS/FAIL PERFORMED
BY/DATE
Operating Procedure
A procedure exists at least in
Draft form.
Maintenance Procedure
A procedure exists at least in
Draft form.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
PROCEDURE VERIFICATION IQ-10
Filter set 3A & 3B
SOP EXPECTED RESULT
ACTUAL RESULT (DOC. NO., REV. NO., TITLE, STATUS) PASS/FAIL PERFORMED
BY/DATE
Operating Procedure
A procedure exists at least in
Draft form.
Maintenance Procedure
A procedure exists at least in
Draft form.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
PROCEDURE VERIFICATION IQ-10
Filter set 4A & 4B
SOP EXPECTED RESULT
ACTUAL RESULT (DOC. NO., REV. NO., TITLE, STATUS) PASS/FAIL PERFORMED
BY/DATE
Operating Procedure
A procedure exists at least in
Draft form.
Maintenance Procedure
A procedure exists at least in
Draft form.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
PROCEDURE VERIFICATION IQ-10
Filter set 5A & 5B
SOP EXPECTED RESULT
ACTUAL RESULT (DOC. NO., REV. NO., TITLE, STATUS) PASS/FAIL PERFORMED
BY/DATE
Operating Procedure
A procedure exists at least in
Draft form.
Maintenance Procedure
A procedure exists at least in
Draft form.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
PROCEDURE VERIFICATION IQ-10
Dual Softener unit
SOP EXPECTED RESULT
ACTUAL RESULT (DOC. NO., REV. NO., TITLE, STATUS) PASS/FAIL PERFORMED
BY/DATE
Operating Procedure
A procedure exists at least in
Draft form.
Maintenance Procedure
A procedure exists at least in
Draft form.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
PROCEDURE VERIFICATION IQ-10
Ozone Generator
SOP EXPECTED RESULT
ACTUAL RESULT (DOC. NO., REV. NO., TITLE, STATUS) PASS/FAIL PERFORMED
BY/DATE
Operating Procedure
A procedure exists at least in
Draft form.
Maintenance Procedure
A procedure exists at least in
Draft form.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
PROCEDURE VERIFICATION IQ-10
Ozone Destructor
SOP EXPECTED RESULT
ACTUAL RESULT (DOC. NO., REV. NO., TITLE, STATUS) PASS/FAIL PERFORMED
BY/DATE
Operating Procedure
A procedure exists at least in
Draft form.
Maintenance Procedure
A procedure exists at least in
Draft form.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
PROCEDURE VERIFICATION IQ-10
Distribution Pumps (1A, 1B)
SOP EXPECTED RESULT
ACTUAL RESULT (DOC. NO., REV. NO., TITLE, STATUS) PASS/FAIL PERFORMED
BY/DATE
Operating Procedure
A procedure exists at least in
Draft form.
Maintenance Procedure
A procedure exists at least in
Draft form.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
PROCEDURE VERIFICATION IQ-10
Distribution Pumps (2A, 2B)
SOP EXPECTED RESULT
ACTUAL RESULT (DOC. NO., REV. NO., TITLE, STATUS) PASS/FAIL PERFORMED
BY/DATE
Operating Procedure
A procedure exists at least in
Draft form.
Maintenance Procedure
A procedure exists at least in
Draft form.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
PROCEDURE VERIFICATION IQ-10
8,000 Gal. Tank
SOP EXPECTED RESULT
ACTUAL RESULT (DOC. NO., REV. NO., TITLE, STATUS) PASS/FAIL PERFORMED
BY/DATE
Operating Procedure
A procedure exists at least in
Draft form.
Maintenance Procedure
A procedure exists at least in
Draft form.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
PROCEDURE VERIFICATION IQ-10
6,000 Gal. Tank
SOP EXPECTED RESULT
ACTUAL RESULT (DOC. NO., REV. NO., TITLE, STATUS) PASS/FAIL PERFORMED
BY/DATE
Operating Procedure
A procedure exists at least in
Draft form.
Maintenance Procedure
A procedure exists at least in
Draft form.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
PROCEDURE VERIFICATION IQ-10
UV lamps (1A, 1B, 2A, 2B)
SOP EXPECTED RESULT
ACTUAL RESULT (DOC. NO., REV. NO., TITLE, STATUS) PASS/FAIL PERFORMED
BY/DATE
Operating Procedure
A procedure exists at least in
Draft form.
Maintenance Procedure
A procedure exists at least in
Draft form.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
PROCEDURE VERIFICATION IQ-10
Dual Reverse Osmosis unit
SOP EXPECTED RESULT
ACTUAL RESULT (DOC. NO., REV. NO., TITLE, STATUS) PASS/FAIL PERFORMED
BY/DATE
Operating Procedure
A procedure exists at least in
Draft form.
Maintenance Procedure
A procedure exists at least in
Draft form.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
PROCEDURE VERIFICATION IQ-10 Degasification unit
SOP EXPECTED RESULT
ACTUAL RESULT (DOC. NO., REV. NO., TITLE, STATUS) PASS/FAIL PERFORMED
BY/DATE
Operating Procedure
A procedure exists at least in
Draft form.
Maintenance Procedure
A procedure exists at least in
Draft form.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
PROCEDURE VERIFICATION IQ-10
Dual Mixed Bed unit
SOP EXPECTED RESULT
ACTUAL RESULT (DOC. NO., REV. NO., TITLE, STATUS) PASS/FAIL PERFORMED
BY/DATE
Operating Procedure
A procedure exists at least in
Draft form.
Maintenance Procedure
A procedure exists at least in
Draft form.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
PROCEDURE VERIFICATION IQ-10
Microza “ultra filtration” filters
SOP EXPECTED RESULT
ACTUAL RESULT (DOC. NO., REV. NO., TITLE, STATUS) PASS/FAIL PERFORMED
BY/DATE
Operating Procedure
A procedure exists at least in
Draft form.
Maintenance Procedure
A procedure exists at least in
Draft form.
Comments/Observations:
Conformance to the acceptance criteria was evaluated and the final determination is as follows: Acceptance Criteria met? (YES/NO) __________ If NO, refer to Deviation # __________
Reviewed by: Date:
IQ CHECKLIST VERIFICATION
Verify each of the respective IQ tests and document completion and status.
TEST NUMBER TEST TITLE
TEST EXECUTED (YES/NO)
ACCEPTANCE CRITERIA
MET? (YES/NO)
DEVIATION NUMBER
(if applies)
DEVIATION SOLVED
(YES/NO)
IQ-01 EQUIPMENT VERIFICATION
IQ-02 DOCUMENT INVENTORY VERIFICATION
IQ-03 DRAWING VERIFICATION
IQ-04 SYSTEM DESIGN VERIFICATION
IQ-05 PLACEMENT VERIFICATION
IQ-06 UTILITY VERIFICATION
IQ-07 INSTRUMENTATION VERIFICATION
IQ-08 MAINTENANCE VERIFICATION
IQ-09 SAFETY AND ERGONOMICS VERIFICATION
IQ-10 PROCEDURE VERIFICATION
Performed by: Date: