Title Page
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Conducted on
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Technician(s) Performing PM
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Jack In the Box #
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Location
HVAC Package Units
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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
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Details/ Descriptions
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UNIT 2
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Details/ Descriptions
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UNIT 3
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Details/ Descriptions
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UNIT 4
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Details/ Descriptions
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Ventilation
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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
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Details/ Descriptions
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Vent Hood System 2
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Details/ Descriptions
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Other/Air Handler
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Details/ Descriptions
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Built In Refrigeration
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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
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Details/ Descriptions
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Walk-In Freezer
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Details/ Descriptions
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Point Of Use (POU) Coolers and Freezers
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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
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Details/ Descriptions
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Front Counter POU Cooler 2
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Details/ Descriptions
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Drive-Thru POU Cooler
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Details/ Descriptions
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French Fry POU Freezer
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Details/ Descriptions
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Fryer POU Dual Zone 1
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Details/ Descriptions
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Fryer POU Dual Zone 2
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Details/ Descriptions
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Chef Stand Cooler
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Details/ Descriptions
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Grill POU Dual Zone
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Details/ Descriptions
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Sandwich ATO/Make Table
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Details/ Descriptions
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Sandwich POU Cooler
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Details/ Descriptions
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Ice Machines
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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
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Details/ Descriptions
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Shake Machine
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List all work performed. Clean all coils, change scraper blades, clean and inspect entire unit.
Shake Machine
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Details/ Descriptions
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Water Filtration
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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
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Details/ Descriptions
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Other Filters
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Details/ Descriptions
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Door Closers
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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
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Details/ Descriptions
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Women's’ RR/Men’s RR/Lobby to Kitchen/Back Door/Drive-Thru 1/Drive Thru 2
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Details/ Descriptions
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Lighting
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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.
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Details/ Descriptions
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Roof
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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
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Details/ Descriptions
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Fryers
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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
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Details/ Descriptions
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Grill
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List all work performed. Check that all grill lanes are properly working and no errors showing on controller box.
Grill
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Details/ Descriptions
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Plumbing Fixtures
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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
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Details/ Descriptions
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Toasters
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List all work performed. Ensure all toasters are working properly and quietly. Repair, adjust, and oil as necessary.
Toasters
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Details/ Descriptions
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Plumbing
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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
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Details/ Descriptions
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Completion
Sign off
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Prepared by (Name and Signature)