Information
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Audit Title
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Document No.
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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
Maintenance Inspection Information
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Maintenance Inspection Date
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Customer
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Property Address (Tenant)
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Technician of Record
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Maintenance Agreement No.
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Maintenance Inspection Visit No.
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Customer Purchase No. (if applicable)
HVAC Equipment Inspected on this Maintenance Visit
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Rooftop Units Inspected
- not inspected on this visit
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
- 13
- 14
- 15
- 16
- 17
- 18:19
- 20
- 21
- 22
- 23
- 24
- 25
- 26
- 27
- 28
- 29
- 30
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Make-Up Units Inspected
- not inspected on this visit
- N/A
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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A/C Split Systems Inspected
- not inspected on this visit
- N/A
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
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Exhaust Fans Inspected
- not inspected on this visit
- N/A
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
- 13
- 14
- 15
- 16
- 17
- 18
- 19
- 20
- 21
- 22
- 23
- 24
- 25
- 26
- 27
- 28
- 29
- 30
- 31
- 32
- 33
- 34
- 35
- 36
- 37
- 38
- 39
- 40
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Radiant Heaters Inspected
- not inspected on this visit
- N/A
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
- 13
- 14
- 15
- 16
- 17
- 18
- 19
- 20
- 21
- 22
- 23
- 24
- 25
- 26
- 27
- 28
- 29
- 30
- 31
- 32
- 33
- 34
- 35
- 36
- 37
- 38
- 39
- 40
- 41
- 42
- 43
- 44
- 45
- 46
- 47
- 48
- 49
- 50
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Unit Heaters Inspected
- not inspected on this visit
- N/A
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 78
- 9
- 10
- 11
- 12
- 13
- 14
- 15
- 16
- 17
- 18
- 19
- 20
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Other Equipment Inspected (quantify/note type)
Rooftop Units/Make-Up Air Units/Split Systems
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Replaced Filter(s) as per Agreement
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Inspect/Test Equipment Electrical Disconnect(s)
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Visual Inspection of Equipment Housing for Damage
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Visual Inspection of Burner Section(s)
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Visual Inspection of Heat Exchanger(s)
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Visual Inspection of Condenser Coil(s)<br>(comment on damage/cleanliness)
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Check Compressor(s) and Component(s)
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Check Condenser Fans and Blades
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Check Voltage and Amperage Draws on Motors
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Inspect Economizer Section Operation/Settings
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Check Controls/Thermostat Operation
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Check/Adjust Belts/Pulleys
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Lubricate Motors/Bearings
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Check Drain Pans and P-Traps
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Inspect Gas Line Piping to Unit<br>(Comment on Pipe Painting/Supports)
Exhaust Fans
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Visual Inspection of Exhaust Fan Housing
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Inspect Exhaust Fan Electrical Disconnect(s)
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Check and Adjust/Replace Exhaust Fan Belts/Pulleys
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Inspect/Check Exhaust Fan Drive Shafts
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Inspect/Check Exhaust Fan Motors (Amperage/Voltage)
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Lubricate Exhaust Fan Motors/Bearings
Radiant Heaters/Unit Heaters
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Check Radiant/Unit Heater Supports & Housing
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Visual Inspection of Radiant/Unit Heater Burner(s)
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Visual Inspection of Heat Exchanger (Comment on Condition)
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Visual Inspection of Radiant Heater Tubing
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Check/Inspect Venting and Air Intakes
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Check/Inspect Gas Lines and Valves
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Test/Check Unit/Radiant Heater Thermostat(s)
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Preventative Maintenance Comments/Recommendations
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I have acknowledged that the work as outlined herein have been preformed and are satisfactory. It is agreed that Fiscom Air Systems Inc. will retain title of any equipment and/or materials that have been furnished during the maintenance visit until final payment has been made. If payment is not made as stated herein, Fiscom Air Systems Inc. shall have the right to remove same and will not be held responsible for any loss/damage resulting form the removal thereof.
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Authorized Signature:
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Maintenance Inspection Report emailed to:
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MAINTENANCE CHARGE
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H.S.T. (#867536120R)
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TOTAL CHARGE
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PAYMENT TERMS: Net 30 days. Two Percent (2%) interest per month charged on overdue accounts. Any dispute regarding this work or invoice must be made within ten (10) days from the invoice date, in writing.
