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| Overall Performance & Trending (STEP) | | |
| Current EHI Score (NUMBER) | | |
| Previous EHI Score (for comparison) (NUMBER) | | |
| Percentage Change in EHI Score (NUMBER) | | |
| Summary of Key Trends Observed in EHI Data (TEXT) | | |
| Overall Assessment of Equipment Health (Based on EHI) (SELECTION options: Excellent, Good, Fair, Poor) | | |
| Areas of Greatest Concern (Based on EHI) (SELECTION options: Mechanical Systems, Electrical Systems, Process Control, Lubrication, Hydraulics) | | |
| Date of Last EHI Review (DATE) | | |
| Recommendations for Further Investigation or Action (TEXT) | | |
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| Vibration Analysis (STEP) | | |
| Overall Vibration Severity Score (RMS) (NUMBER) | | |
| Axial Vibration (mm/s) (NUMBER) | | |
| Radial Vibration (mm/s) (NUMBER) | | |
| Tangential Vibration (mm/s) (NUMBER) | | |
| Phase Analysis (if applicable) (SELECTION options: Normal, Phase Shift Detected, Unstable Phase, Not Applicable) | | |
| Description of Observed Vibration Patterns (TEXT) | | |
| Vibration Spectrum Graph (UPLOAD) | | |
| Impulse Characteristics (if present) (SELECTION options: None, Low, Moderate, High) | | |
| Date of Last Vibration Analysis (DATE) | | |
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| Oil Analysis (STEP) | | |
| Viscosity (cSt @ 40°C) (NUMBER) | | |
| Total Base Number (TBN) (mg KOH/g) (NUMBER) | | |
| Acid Number (AN) (mg KOH/g) (NUMBER) | | |
| Water Content (%) (NUMBER) | | |
| Wear Metal Concentration - Iron (ppm) (NUMBER) | | |
| Wear Metal Concentration - Copper (ppm) (NUMBER) | | |
| Particle Contamination (ISO Code) (SELECTION options: ISO 00, ISO 03, ISO 06, ISO 09, ISO 12, ISO 14, ISO 16, ISO 18, ISO 21, ISO 24) | | |
| Observations/Comments on Oil Condition (TEXT) | | |
| Oil Sample Date (DATE) | | |
| Oil Analysis Report (UPLOAD) | | |
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| Thermography (Infrared Scanning) (STEP) | | |
| Maximum Hotspot Temperature (Surface °C) (NUMBER) | | |
| Ambient Temperature (°C) (NUMBER) | | |
| Emissivity Value Used (NUMBER) | | |
| Description of Hotspot Anomalies Observed (if any) (TEXT) | | |
| Areas Inspected (Select all that apply) (SELECTION options: Electrical Panels, Motors & Drives, Pumps, Gearboxes, Process Piping, HVAC Systems, Other (Specify in long text)) | | |
| Overall Thermal Image Quality (SELECTION options: Excellent, Good, Fair, Poor) | | |
| Date of Thermography Scan (DATE) | | |
| Time of Thermography Scan (DATE) | | |
| Attach Thermography Image(s) (UPLOAD) | | |
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| Ultrasonic Testing (STEP) | | |
| Bearing Outer Race Defect Amplitude (dB) (NUMBER) | | |
| Bearing Inner Race Defect Amplitude (dB) (NUMBER) | | |
| Bearing Ball/Roller Defect Amplitude (dB) (NUMBER) | | |
| Gear Mesh Frequency Amplitude (dB) (NUMBER) | | |
| Description of Detected Anomalies (if any) (TEXT) | | |
| Leak Detection Status (SELECTION options: No Leaks Detected, Minor Leak Detected, Significant Leak Detected, Leak Location Unknown) | | |
| Ultrasonic Sound Waveforms/Spectrum (UPLOAD) | | |
| Date of Ultrasonic Testing (DATE) | | |
| Time of Ultrasonic Testing (DATE) | | |
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| Process Parameter Monitoring (STEP) | | |
| Production Rate (Units/Hour) (NUMBER) | | |
| Operating Pressure (PSI) (NUMBER) | | |
| Operating Temperature (Degrees Celsius) (NUMBER) | | |
| Power Consumption (kW) (NUMBER) | | |
| Cycle Time (Normal Range) (SELECTION options: Within Specification, Slightly Outside, Significantly Outside) | | |
| Observed Process Anomalies/Deviations (TEXT) | | |
| Date of Last Process Parameter Calibration (DATE) | | |
| Process Parameter Stability (SELECTION options: Stable, Slightly Fluctuating, Highly Fluctuating) | | |
| Actions Taken Regarding Process Parameter Deviations (TEXT) | | |
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| Data Integrity and Reliability (STEP) | | |
| Data Source Accuracy Score (1-10) (NUMBER) | | |
| Data Source Verification Method (SELECTION options: Manual Review, Automated Validation, Calibration Records, Third-Party Audit) | | |
| Last Data Source Validation Date (DATE) | | |
| Description of Data Validation Procedures (TEXT) | | |
| Data Transmission Method (SELECTION options: Direct Connection, Wireless, Networked, Manual Entry) | | |
| Data Loss Rate (%) (NUMBER) | | |
| Notes on data inconsistencies or anomalies detected (TEXT) | | |
| Calibration Status of Sensors (SELECTION options: Within Calibration Period, Calibration Needed, Calibration Overdue) | | |
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| Alarm Management & Response (STEP) | | |
| Number of Unacknowledged Alarms (NUMBER) | | |
| Alarm Response Protocol Followed? (SELECTION options: Yes, No, N/A) | | |
| Brief Description of Alarm Response Actions Taken (TEXT) | | |
| Date of Last Alarm Response Training (DATE) | | |
| Average Time to Acknowledge an Alarm (DATE) | | |
| Root Cause Analysis Performed for Recurring Alarms? (SELECTION options: Yes, No, N/A) | | |
| Summary of Findings from Root Cause Analysis (if applicable) (TEXT) | | |
| Attach screenshot of recent alarm log (if applicable) (UPLOAD) | | |
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| Maintenance History Review (STEP) | | |
| Number of Preventative Maintenance (PM) Tasks Completed on Time (NUMBER) | | |
| Summary of Recurring Failure Modes (TEXT) | | |
| Date of Last Major Overhaul (DATE) | | |
| Mean Time Between Failures (MTBF) – Current Value (NUMBER) | | |
| Number of Unexpected Breakdowns in the Past 12 Months (NUMBER) | | |
| Detailed Description of Most Recent Significant Repair (TEXT) | | |
| Root Cause Analysis (RCA) Documentation Available? (SELECTION options: Yes, No, Partially Available) | | |
| Upload Maintenance Records/Logs (Optional) (UPLOAD) | | |
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| Corrective Action Effectiveness (STEP) | | |
| Pre-Corrective Action EHI Score (NUMBER) | | |
| Post-Corrective Action EHI Score (NUMBER) | | |
| Corrective Action Category (SELECTION options: Mechanical, Electrical, Process, Lubrication, Software/Control System) | | |
| Description of Corrective Action Taken (TEXT) | | |
| Root Cause Identified (Initial Assessment) (SELECTION options: Wear, Misalignment, Contamination, Design Flaw, Operator Error, Other) | | |
| Root Cause Verification Method (SELECTION options: Visual Inspection, Vibration Analysis, Oil Analysis, Thermography, Ultrasonic Testing) | | |
| Description of Actual Root Cause (If Different) (TEXT) | | |
| Was the Corrective Action Effective? (SELECTION options: Yes, No, Partially) | | |
| Explanation for Effectiveness Rating (If Partially or No) (TEXT) | | |
| Date of Follow-Up Review (DATE) | | |