HVAC Preventive Maintenance Form

HVAC Preventive Maintenance Form
Equipment Information
Location/Building Name
Equipment ID/Serial Number
Date of Maintenance
MonthDayYear
Date
Maintenance Technician Information
Technician Name
First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Preventive Maintenance Checklist
Filters
InspectedCleanedReplaced (if needed)
Coils
InspectedCleanedReplaced (if needed)
Blower Motor
InspectedLubricatedReplaced (if needed)
Belts and Pulleys
InspectedAdjustedReplaced (if needed)
Refrigerant Levels
Checked and adjusted (if needed)
Thermostat
CalibratedTested
Electrical Connections
InspectedTightenedReplaced (if needed)
Condensate Drain
InspectedCleared of obstructions
Ductwork
Inspected for leaksSealed (if needed)
Safety Controls
Tested
Please provide any additional notes, recommendations, or comments related to the maintenance.
List any recommended actions or repairs that should be addressed in the future.
I confirm that the preventive maintenance of the HVAC system was completed as per the checklist above.
Date
MonthDayYear
Date
Signature
Clear
Should be Empty:

Equipment Information