HVAC Preventive Maintenance Form

Location/Building Name

Equipment ID/Serial Number

Date of Maintenance

Date

Technician Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Filters

Coils

Blower Motor

Belts and Pulleys

Refrigerant Levels

Thermostat

Electrical Connections

Condensate Drain

Ductwork

Safety Controls

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

Signature

Equipment Information