Title Page

  • Store Name/Store Number

  • Conducted on

  • Engineer Name

  • Work Order Number/Task ID

  • PLANT

  • Pack/Cond
  • Pack/Cond Unit ID

  • Asset Tag

  • Low Side PRV-rated (BAR) and expiry date (please state the make an model of PRV)

  • High Side PRV-rated (BAR) and expiry date. (Please state make and model of PRV)

  • Refrigerant Type

  • Entrained Volume (KG)

  • Number of Leaks Found

  • Notes

  • Integral
  • Integral Cab ID

  • Asset Tag

  • Refrigerant Type

  • Entrained Volume (Kg/g)

  • Number of Leaks Found

  • Notes

  • Start Date and Time

  • Finish Date and Time

  • Total Hours

  • Manager Signature

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.