Sample Monthly Reporting
                         Form

                         Plant:

                         Superint...
3. (For wastewater treatment plants) BOD removal goal (in pounds) for
   month:

   Actual pounds removed

   If less than...
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Sample Reporting Forms

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water and wastewater local officials handbook

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Sample Reporting Forms

  1. 1. Sample Monthly Reporting Form Plant: Superintendent Filing Report: Date: (report due by 5th of each month) 1. Maintenance Helpful Guidance This form a) Describe in a few sentences all major preventive maintenance work assembles a set of carried out during the month. questions designed to improve b) Describe any emergency repairs that were required during the month. communication Explain cause. between plant staff and local officials. c) Describe any preventive maintenance projects planned for the next By gathering this month. information each month, the plant d) Describe the potential for possible emergency failures of equipment superintendent has or systems in the near future. an opportunity to identify the utility’s needs, problem 2. Energy usage at the treatment plant areas, and successes. When local officials know a) From master meter, kWh at beginning of month what is happening at the plant they From master meter, kWh at end of month are able to better manage, plan, and Daily average budget for the system. Previous month’s daily average From annual budget, projected average daily kWh b) List here any possible energy efficiency equipment replacements whose energy savings would have a ten-year or less payback. Sample Monthly Reporting Form L–1
  2. 2. 3. (For wastewater treatment plants) BOD removal goal (in pounds) for month: Actual pounds removed If less than goal, state reason here. If goal was exceeded, state how achieved and whether greater removal rates are possible over the long term. At what percentage of design organic loading did the plant operate during the month? At what percentage of design hydraulic loading did the plant operate during the month? 4. (For water treatment plants) Finished water production goal for month, millions of gallons: Actual production of finished water for month At what percentage of production capacity did the water plant operate for the month? 5. List all violations for the month, whether or not reported to state regulators. As best as possible, state seriousness of each. Describe all corrective actions taken for each violation. 6. Describe briefly any professional development, certification, or train- ing activities undertaken by staff during the month, either as trainers or trainees. Give contact hours. Was the plant the beneficiary of any technical assistance from “outside” sources during the month, either contracted for or given free of charge? Describe briefly. 7. During the upcoming month, will there be any special cash needs for one-time expenditures in excess of $1000? If so, describe below. 8. Give names and position titles of all new hires made during the month. 9. Briefly describe below any other events, needs, or “news” from the treatment plant not specifically called for above. L–2 Local Officials Handbook

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