Title Page

  • Site Number:

  • Conducted on:

  • Prepared by:

  • Location:

Store Information

  • Picture of Store Number

  • Take Walk In Cooler/Freezer Photos

  • Take Thermostat Photos

  • Photo of Roof Access Point

  • Wide Photo of Roof Top or Condenser Areas (Showing all units)

Unit Information

  • How many Units?

  • Is Unit 1 RTU or AHU?

  • Wide Photo of Unit

  • Photo of Unit Label

  • Is the Unit powered on?

  • Power off the Unit

  • Take a Picture of the Electrical Cutoff showing its off

  • Manufacturer:

  • Unit Model Number:

  • Unit Serial Number:

  • Motor Horsepower:

  • Motor Voltage:

  • Motor Phase:

  • Compressor Voltage:

  • Compressor Phase:

  • Number of Compressors:

  • Wide Relay Section Photos:

  • Thermostat Connection / Terminal Strip:

  • Compressor Area:

  • Filters:

  • Inflow Air: Economozer? Accuator? Dampers?

  • Wide Blower Section:

  • Motor Label:

  • Motor Positioning: Any Clearance Issues?

  • Belt Size:

  • Belt Size:

  • Motor Shaft Measurement:

  • Wide Blower Photo:

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.