Title Page

  • Prepared by

  • Conducted on

  • Branch Location

Refrigerant Handling License Information

  • Refrigerant Handling License Number

  • Refrigerant Handling License Expiry Date

  • Refrigerant Handling License Type

  • Take A Photo Of Your Refrigerant Handling License

  • Leak Detector Details
  • Leak Detector Make

  • Leak Detector Model

  • Leak Detector Serial Number

  • Inspect The Leak Detector any list any damage or issues

  • Take a photo of the leak detector

  • Recovery Unit Details
  • Recovery Unit Make

  • Recovery Unit Model

  • Recovery Unit Serial Number

  • Inspect The Recovery Unit and list any damage, issues or maintenance performed

  • Take a photo of the Recovery Unit

  • Recovery Cylinder Details
  • Recovery cylinders must be stored upright and caged or chained so they cannot be knocked all fall over, must be stored below 50 degrees celcius, must be stored in a dry well ventilated area, must be protected from salt and corrosive chemicals, must be labelled properly and must be inspected for damage, deterioration, leaks or tampering. Recovery cylinders must be fitted with an isolating valve and flare cap. The valve must be turned off and the flare port capped securely while the cylinder is not in use. All cylinders must not be used if more than 10 years has elapsed since the last inspection date.

  • Date Of The Recovery Cylinders Last Pressure Test

  • Recovery Cylinder Make

  • Recovery Cylinder Serial Number

  • Recovery Cylinder Model (kg)

  • Inspect The Recovery Cylinder and list any damage or issues

  • Is the Recovery Cylinder Stored Upright and Secured In a Cage or by a chain?

  • Take a photo of the Recovery Cylinder

  • Refrigerant Cylinder Details
  • All Cylinders must be stored upright and caged or chained so they cannot be knocked all fall over, must be stored below 50 degrees celcius, must be stored in a dry well ventilated area, must be protected from salt and corrosive chemicals, must be labelled properly and must be inspected for damage, deterioration, leaks or tampering. All cylinders must not be used if more than 10 years has elapsed since the last inspection date.

  • Date Of The Cylinders Last Pressure Test

  • Cylinder Owner

  • Cylinder Serial Number

  • Cylinder Refrigerant Type

  • Inspect The Recovery Cylinder and list any damage or issues

  • Is the Refrigerant Cylinder Stored Upright and Secured In a Cage or by a chain?

  • Take a photo of the Refrigerant Cylinder

  • Vacuum Pump Details
  • Vacuum Pumps must have their oil changed every 3 months,

  • Vacuum Pump Make

  • Vacuum Pump Model

  • Vacuum Pump Serial Number

  • Inspect The Vacuum Pump and list any damage or issues

  • When was the last oil changed performed

  • Take a photo of the Vacuum Pump

  • Refrigerant Dispensed Details
  • Property Address Where The Refrigerant Was Dispensed
  • Date Refrigerant Dispensed

  • Pindan Work Order Refrigerant Dispensed On

  • Type Of Asset The Refrigerant Was Dispersed To

  • Refrigerant Type Dispersed

  • Refrigerant Weight Dispersed (kg)

  • Cylinder Serial Number Refrigerant Dispersed From

  • Refrigerant Reclaimed Details
  • Property Address Where The Refrigerant Was Reclaimed
  • Date Refrigerant Reclaimed

  • Pindan Work Order Refrigerant Reclaimed On

  • Type Of Asset The Refrigerant Was Reclaimed From

  • Refrigerant Type Reclaimed

  • Refrigerant Weight Reclaimed (kg)

  • Cylinder Serial Number Refrigerant Reclaimed To

  • Refrigerant Gas Supplier Name

  • Refrigerant Received
  • Date Refrigerant Received

  • Pindan Purchase Order Number

  • Refrigerant Type

  • Refrigerant Weight Received

  • Cylinder Serial Number Received

  • Refrigeration Vehicle Compliance
  • Vehicle Registration Number

  • Does this vehicle have provision to transport safely refrigerant cylinders so that they are chained or caged, are upright and cannot fall over?

  • Take a photo of the provisions on this vehicle to transit refrigerant gases safely and securely

  • List any issues you have with transporting refrigerants

  • Have you got a copy AND read the Pindan Asset Management Refrigerant Risk Management Plan

  • List any comments or issues you would like to raise

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.