Inspection/Maintenance Report
Date Of Inspection/Maintenance
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Job Name
Job Location
Street Address
Street Address Line 2
City
State
Zip Code
Type of Maintenance
Annual
Requested
Scheduled
Courtesy
Pump System
Booster
Groundwater
Sewage
PRV Body
*
Rows
Pump 1
Pump 2
Pump 3
Cleaned
1
2
3
Replaced
4
5
6
Stem
*
Rows
Pump 1
Pump 2
Pump 3
Cleaned
7
8
9
Replaced
10
11
12
Diaphragm
*
Rows
Pump 1
Pump 2
Pump 3
Cleaned
13
14
15
Replaced
16
17
18
Disc
*
Rows
Pump 1
Pump 2
Pump 3
Cleaned
19
20
21
Replaced
22
23
24
Disc Guide
*
Rows
Pump 1
Pump 2
Pump 3
Cleaned
25
26
27
Replaced
28
29
30
Seats
*
Rows
Pump 1
Pump 2
Pump 3
Cleaned
31
32
33
Replaced
34
35
36
Ports
*
Rows
Pump 1
Pump 2
Pump 3
Cleaned
37
38
39
Replaced
40
41
42
Strainers
*
Rows
Pump 1
Pump 2
Pump 3
Cleaned
43
44
45
Replaced
46
47
48
Pilots
*
Rows
Pump 1
Pump 2
Pump 3
Cleaned
49
50
51
Replaced
52
53
54
Pilot Diaphragm
*
Rows
Pump 1
Pump 2
Pump 3
Cleaned
55
56
57
Replaced
58
59
60
Pilot Seat
*
Rows
Pump 1
Pump 2
Pump 3
Cleaned
61
62
63
Replaced
64
65
66
Orifice
*
Rows
Pump 1
Pump 2
Pump 3
Cleaned
67
68
69
Replaced
70
71
72
Check valves
*
Rows
Pump 1
Pump 2
Pump 3
Cleaned
73
74
75
Replaced
76
77
78
Check valves
*
Rows
Pump 1
Pump 2
Pump 3
Cleaned
79
80
81
Replaced
82
83
84
PRV Comments
PRV Pictures for Record
Browse Files
Cancel
of
OverHeat Thermostats
*
Rows
Pump 1
Pump 2
Pump 3
Cleaned
85
86
87
Replaced
88
89
90
OverHeat Thermostat Condition
*
Rows
Pump 1
Pump 2
Pump 3
Like New
91
92
93
Replace Soon
94
95
96
Corroded
97
98
99
Thermostat Pictures for Record
Browse Files
Cancel
of
Solenoid Valves
*
Rows
Pump 1
Pump 2
Pump 3
Cleaned
100
101
102
Replaced
103
104
105
Motor Amperage
Rows
L1
L2
L3
Pump 1
Pump 2
Pump 3
Grease Motors
Motor 1
Motor 2
Motor 3
No motors greased
No grease ports
Mechanical Seal
*
Rows
Pump 1
Pump 2
Pump 3
Cleaned
106
107
108
Replaced
109
110
111
Condition of Mechanical Seal
*
Rows
Pump 1
Pump 2
Pump 3
Like New
112
113
114
Functional
115
116
117
Replace soon
118
119
120
Leaking
121
122
123
Overall condition of Piping
1
2
3
4
5
Overall condition of Piping
Piping Pictures for Record
Browse Files
Cancel
of
Panel Items
Mag-Starter Contacts
*
Rows
Pump 1
Pump 2
Pump 3
Cleaned
124
125
126
Replaced
127
128
129
Mag-Starter Wiring
*
Rows
Pump 1
Pump 2
Pump 3
Tightened
130
131
132
Replaced
133
134
135
Pressure Switches
*
Rows
Setting
Low System Pressure
Low Suction
High System
Hydro Circuit
Conclusion and Signature
Take Photo
Take Photo
Take Photo
Take Photo
Take Photo
Conclusion
*
Inspection has passed
Inspection has failed
Incomplete (need to return)
Technician Signature
*
Submit
Should be Empty: