1. The first copy is for the personal responsible for the director of maintenance services
2. The second copy is for the national distributors for statistical purposes
3. The third copy is for the maintenance operator or his office
-Questions marked "A" ("always") must ALWAYS be answered
-Questions marked "V" ("variable") need be answered only the first time the report is prepared and thereafter only where there have been variations to the information previously given.
-Questions marked "M" ("management") must be completed by the coordinating manager
010 | A | Unit series number |                    |
011 | V | Pump type |                    |
012 | V | Project reference |                    |
013 | A | Village/location |                    |
014 | V | Borehole/well reference |                    |
015 | V | Date of installation |                    |
016 | M | Total months since installation |                    |
017 | V | Actual static water level in meters |                    |
018 | A | Series number this visit |                    |
020 | V | Type/size PV array/wind generator |                     |
021 | V | Direct or battery driven |                     |
022 | V | Type/series number controller |                     |
023 | V | Type/size/length of electric cable |                     |
024 | V | Type/size/length of feed pipe |                     |
025 | V | Type/model of float switch |                     |
026 | V | Maximum pump submergence in meters |                     |
027 | V | Total head to feed pipe outlet in meters |                     |
028 | V | Horizontal distance from source to outlet in meters |                     |
029 | V | Type,size and sealing of tank/reservoir |                     |
030 | A | Name |                     |
031 | A | Answering to |                     |
032 | A | Have you got your maintenance manual with you? |                     |
033 | A | When did you last update your kit? |                     |
034 | A | Means of transport used |                     |
035 | A | Location last unit visited |                     |
036 | A | Distance away last unit visited |                     |
037 | A | Location next unit to be visited |                     |
038 | A | Distance away next unit to be visited |                     |
040 | A | Date this visit |                     |
041 | A | Date last visit to this unit |                     |
042 | A | Time this visit began |                     |
043 | A | Time this visit ended |                     |
044 | A | Travelling time this visit |                     |
045 | M | Accumulated time (travelling/work) this unit |                     |
046 | A | Is this a systenatic preventive maintenance visit? |                     |
047 | A | If not,who called you? |                     |
048 | A | When were you called? |                     |
050 | V | Number of people served by pump |                     |
051 | V | Number of animals served. Specify which |                     |
052 | V | Crops/trees served. Specify which |                     |
053 | V | Estimated average hours' use per day |                     |
054 | A | Estimated total hours' use since last visit |                     |
055 | V | Estimated average capacity of pump in liters/min |                     |
056 | A | Estimated cubic meters pumped since last visit |                     |
057 | M | Estimated cubic meters pumped this unit |                     |
058 | V | Estimated average queuing time |                     |
059 | V | Distance away alternative water source in meters |                     |
060 | A | Is run-off area dry and clean? |                     |
061 | A | Are the approaches to the collection point dry and clean? |                     |
062 | A | Condition of tank or reservoir |                     |
063 | A | Appearance of water |                     |
064 | A | Odour of water |                     |
065 | A | Taste of water |                     |
066 | V | Types of users' recipients |                     |
067 | V | Cleanliness users' recipients |                     |
068 | V | Presence of water-borne diseases amongst users |                     |
069 | V | General state of health of users |                     |
070 | A | Is the pump working normally? |                     |
071 | A | Is the pump working, but not well? |                     |
072 | A | Has the pump broken down? |                     |
073 | A | If so, state period of loss of use in days |                     |
074 | M | Total period of loss of use this pump |                     |
075 | A | Condition of PV/wind generator |                     |
076 | V | Condition/appearance of controller |                     |
077 | V | Condition/appearance of electric cable |                     |
078 | V | Condition/appearance of feed pipe |                     |
079 | V | Condition/appearance of well/head |                     |
080 | A | Controller self-diagnostics checked? |                     |
081 | A | Irregularities LED lights noted? |                     |
082 | A | Was pump pulled out of well/borehole? |                     |
083 | A | Condition of feedpipe, cable and safety rope OK? |                     |
084 | A | Was pump opened? |                     |
085 | A | Was outlet group dismantled? |                     |
086 | A | Was valve group dismantled? |                     |
087 | A | Was pump body group dismantled? |                     |
088 | A | Were piston groups dismantled? |                     |
089 | A | Was the motor group opened? |                     |
090 | A | Broken parts replaced (ref. numbers) |                     |
091 | A | Cause of damage if not wear and tear |                     |
092 | A | Parts showing wear and tear replaced (ref.numbers) |                     |
093 | A | Parts showing wear and tear for future replacement (ref.nos) |                     |
094 | A | Operator's comments |                     |
095 | M | Operator's fee/tavelling this visit |                     |
096 | M | Fees/travelling paid by/through |                     |
097 | M | Cost of spare parts used this visit |                     |
098 | M | Spare parts paid by/through |                     |
100 | M | Total operator's fees/travelling costs this unit |                     |
101 | M | Total parts costs this unit |                     |
102 | M | Total accumulated fees and parts costs this unit |                     |
103 | M | Relation in % 102 to 057 in euros/m3 water |                     |
104 | M | Relation in % 102 to 016 in euros/month |                     |
110 | M | Is there a servicing contract for this visit? |                     |
111 | M | Amount collected under service contract |                     |
112 | M | Is there insurance applicable to this visit? |                     |
113 | M | Amount collected under the insurance policy |                     |
114 | M | Amount collected for this visit directly from user |                     |
115 | M | Total recovered this visit |                     |
116 | M | Total recovered all visits this unit |                     |
117 | M | Net cost of parts this visit |                     |
118 | M | Total net cost of parts this unit |                     |
119 | M | Net cost artisan/travelling this visit |                     |
120 | M | Total net cost artisan/travelling this unit |                     |
121 | M | Total outgo costs this unit (118+120) |                     |
122 | M | Net economic result (116-121) this unit excluding ammortisation |                     |
123 | M | Accumulated ammortisation of pump set |                     |
124 | M | Accumulated ammortisation of PV/wind generator/battery |                     |
125 | M | Accumulated ammortisation of well/borehole costs |                     |
126 | M | Accumulated system ammortisation (123+124+125) |                     |
127 | M | Accumulated ammortisation + costs (126+122) this unit |                     |
128 | M | Total system costs (127) to cubic meter of water pumped (Net cost artisan/travelling this visit (057) |                     |
129 | M | Total system costs (127) per month (016) |                     |