Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Date and Time
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Building
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Room Number
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Damper #
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Take photo of damper
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Affix Damper ID# to area nearest damper
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Visually Inspect Damper for signs of failure
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Clean tracks and mechanism for damper movement
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Carefully remove fusible link ( if possible to do so without damage )
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Actuate damper through entire length of travel
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Note all issues associated with movement of damper
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Place damper on original position
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Replace fusible link
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Note any issues with final damper position/condition
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Satisfactory
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Unsatisfactory
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Additional Notes if Unsatisfactory
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Add signature
