Preventive Maintenance Inspection

• Site conducted

  Select
• Job Address
  Address

• Inspection Date

  Date

• Dispatch #

• HVAC Technician

  Select Bob Hedberg Chris Winters Dan Freeman Dan McKinnon Jeremey Butler Kyle Kawa Tyler Zitzka

  • Bob Hedberg
  • Chris Winters
  • Dan Freeman
  • Dan McKinnon
  • Jeremey Butler
  • Kyle Kawa
  • Tyler Zitzka

• Type of Equipment

  Select AHU Boiler Chiller Exhaust Fan MUA RTU Unit Heater

  • AHU
  • Boiler
  • Chiller
  • Exhaust Fan
  • MUA
  • RTU
  • Unit Heater

• Equipment Tag

• Serial Number

• Model Number

• Make

• Year

• Filters

  Good

  Replaced

  Need Replacement

  N/A

• Belts

  Good

  Replaced

  Need Replacement

  N/A

• Drive/Pulleys

  Safe

  At Risk

  N/A

• Economizer / Outside Air

  Pass

  Fail

  N/A

• Refrigeration Safety Controls

  Pass

  Fail

  N/A

• Condenser / Evaporator Coils

  Good

  Fair

  Poor

  N/A

• Condensate Drain / Lines clear

  Pass

  Fail

  N/A

• Condenser Fan Motor (s)

  Pass

  Fail

  N/A

• Compressor (s)

  Pass

  Fail

  N/A

• Refrigeration Pressures

  Pass

  Fail

  N/A

• Heat Exchangers / Burners

  Pass

  Fail

  N/A

• Electric Heat

  Pass

  Fail

  N/A

• Heat Staging Properly

  Pass

  Fail

  N/A

• Heat Safety Controls

  Pass

  Fail

  N/A

• Flame Sensors and Ignitors

  Pass

  Fail

  N/A

• Inducer Motor

  Pass

  Fail

  N/A

• Contactors

  Good

  Fair

  Poor

  N/A

• Electrical Connections Secure

  Yes

  No

  N/A

EXHAUST FANS

• Belts

  Good

  Replaced

  Need Replacement

  N/A

• Drive/Pulleys

  Safe

  At Risk

  N/A

• Pulley Alignment

  Pass

  Fail

  N/A

• Bearings

  Pass

  Fail

  N/A

• Motor Amperage

• Lubricated Parts

  Yes

  No

  N/A

CHILLER / BOILER

• Controls, Timers, Safeties and Gauges

  Good

  Fair

  Poor

  N/A

• Compressor Oil Sight Glass at Correct Level

  Yes

  No

  N/A

• Electrical Connections Secure

  Yes

  No

  N/A

• Condenser Coil

  Good

  Fair

  Poor

  N/A

• Voltage

• Amperage

CHECKLIST

• Overall Condition of Equipment

  Good

  Fair

  Poor

  N/A

• All Panels are Securely Fastened

  Yes

  No

  N/A

• All Equipment Areas are Clean

  Yes

  No

  N/A

• On-Site Manager or Supervisor at Time of Inspection

• Signature

  Sign