A/C Leak Check PPM

• Document No.

• Conducted on

  Date
• Location
  Address

Introduction

• Store Name

• Job Number

• Add Condensing unit (Outdoor)

Condensing unit

• Location

• Make of unit

  Select Mitsubishi Daikin IMI Sanyo Toshiba Fujitsu DeLonghi Carrier Other

  • Mitsubishi
  • Daikin
  • IMI
  • Sanyo
  • Toshiba
  • Fujitsu
  • DeLonghi
  • Carrier
  • Other

• Asset number

• Serial Number

• Leak Present

  Yes

  No

• Reactive job number if leak found

• Minor repair carried out?

  Yes

  No

• Comments

• Add Evaporating unit (Indoor)

Evaporating unit

• Location

• Make of unit

  Select Mitsubishi Daikin IMI Sanyo Toshiba Fujitsu DeLonghi Carrier Other

  • Mitsubishi
  • Daikin
  • IMI
  • Sanyo
  • Toshiba
  • Fujitsu
  • DeLonghi
  • Carrier
  • Other

• Asset number

• Serial Number

• Leak Present

  Yes

  No

• Reactive job number if leak found

• Minor repair carried out?

  Yes

  No

• Comments

• Name and Signature

  Sign