Title Page

  • Conducted on

  • Technician(s) Performing PM

  • Jack In the Box #

  • Location

HVAC Package Units

  • Please list all work performed and additional items/work needed or recommended. Minimum is to clean coils with chemical and rinse very well, thoroughly flush drain line, replace pleated filters, check/adjust pressures, check/replace belts,change thermostat batteries set program and lock.

UNIT 1

  • Details/ Descriptions

  • Add photos

UNIT 2

  • Details/ Descriptions

  • Add photos

UNIT 3

  • Details/ Descriptions

  • Add photos

UNIT 4

  • Details/ Descriptions

  • Add photos

Ventilation

  • Please list all work performed and additional items/work needed or recommended. Minimum is to check/adjust/replace belts and pulleys, ensure positive air flow in building, and set lobby humidistat to 50 degrees and lock in place with bead of silicone.

Vent Hood System 1

  • Details/ Descriptions

  • Add photos

Vent Hood System 2

  • Details/ Descriptions

  • Add photos

Other/Air Handler

  • Details/ Descriptions

  • Add photos

Built In Refrigeration

  • Please list all work performed and additional items/work needed or recommended. Minimum is to clean coils with chemical and rinse very well, thoroughly flush drain line, clean fan covers and blades, inspect/replace motors/blades, check defrost timer and all connectors, check/replace door hinges and gaskets, replace damaged or missing air curtains.

Walk-In Cooler

  • Details/ Descriptions

  • Add photos

Walk-In Freezer

  • Details/ Descriptions

  • Add photos

Point Of Use (POU) Coolers and Freezers

  • Please list all work performed and additional items/work needed or recommended. Minimum is to clean coils well with chemicals as needed, thoroughly flush drain line, clean fan cover and blades, inspect/replace motor and blades, check/adjust/replace door hinges and gaskets

Front Counter POU Cooler 1

  • Details/ Descriptions

  • Add photos

Front Counter POU Cooler 2

  • Details/ Descriptions

  • Add photos

Drive-Thru POU Cooler

  • Details/ Descriptions

  • Add photos

French Fry POU Freezer

  • Details/ Descriptions

  • Add photos

Fryer POU Dual Zone 1

  • Details/ Descriptions

  • Add photos

Fryer POU Dual Zone 2

  • Details/ Descriptions

  • Add photos

Chef Stand Cooler

  • Details/ Descriptions

  • Add photos

Grill POU Dual Zone

  • Details/ Descriptions

  • Add photos

Sandwich ATO/Make Table

  • Details/ Descriptions

  • Add photos

Sandwich POU Cooler

  • Details/ Descriptions

  • Add photos

Ice Machines

  • List all work performed. Clean all coils, run cleaner through machine, and sanitize bins as required. Lobby Ice Machine/Drive Thru Ice Machine/Kitchen Ice Machine

Ice Machines

  • Details/ Descriptions

  • Add photos

Shake Machine

  • List all work performed. Clean all coils, change scraper blades, clean and inspect entire unit.

Shake Machine

  • Details/ Descriptions

  • Add photos

Water Filtration

  • List all work performed. Change main “Selecto” water filter and put date on newly installed filter (1 time per year). Change any additional water filters as needed, date filters and list.

Selecto Filter

  • Details/ Descriptions

  • Add photos

Other Filters

  • Details/ Descriptions

  • Add photos

Door Closers

  • Check that all door closers meet ADA requirements, and adjust/replace as necessary. Check and repair/replace any missing or damaged door lock pins and lanyards. For Drive thru, check that doors close and lock properly and that air curtains are working.

Lobby/Vestibule

  • Details/ Descriptions

  • Add photos

Women's’ RR/Men’s RR/Lobby to Kitchen/Back Door/Drive-Thru 1/Drive Thru 2

  • Details/ Descriptions

  • Add photos

Lighting

  • List all work performed. Ensure all lights in the following locations are working: Interior Menuboard/Interior Breakfast Panel/Drive Thru Presell/Drive Thru Main/Kitchen Lights/Lobby Lights/Restroom Lights Check here that the lighting timeclock has been checked and is set correctly

Lighting.

  • Details/ Descriptions

  • Add photos

Roof

  • List all work performed. Ensure roof is clean and clear of any debris, all drains are clear and open and associated drain covers are in place.

Roof

  • Details/ Descriptions

  • Add photos

Fryers

  • List all work performed. Check that all fryers are working properly and are properly calibrated to the temperature on the knob. Replace all fryer relays (1 time/year). All rubber boots on fryers must be inspected for leaks (must drain all to see).

Fryers

  • Details/ Descriptions

  • Add photos

Grill

  • List all work performed. Check that all grill lanes are properly working and no errors showing on controller box.

Grill

  • Details/ Descriptions

  • Add photos

Plumbing Fixtures

  • List all work performed. Check to ensure all bathroom fixtures are working properly and not leaking. Replace all batteries in any automatic valves. Check all the following: Toilets/Urinal/Sinks/Paper Towel Dispenser

Plumbing Fixtures

  • Details/ Descriptions

  • Add photos

Toasters

  • List all work performed. Ensure all toasters are working properly and quietly. Repair, adjust, and oil as necessary.

Toasters

  • Details/ Descriptions

  • Add photos

Plumbing

  • List all work performed. Check all water faucets for leaks and repair as needed. In 3 compartment sink area, ensure all sinks hold water and replace gaskets as needed, and ensure switching valve between sprayer and faucet work properly and do not leak, and that sprayer works properly and does not leak. Check all including: 3 different hand sinks in kitchen, mop sink, 3 compartment sink, Dumpster Area faucets and drain, lobby drink station, drive thru drink station.

Plumbing

  • Details/ Descriptions

  • Add photos

Completion

Sign off

  • Prepared by (Name and Signature)

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