Chilled Water System Inspection Checklist
Please complete this checklist to document your inspection of the chilled water system.
Inspection Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Inspector Name
*
First Name
Last Name
Inspection Location or System ID
*
Component Inspection Ratings
*
Rows
Good
Fair
Poor
Chiller Unit
1
2
3
Pumps
4
5
6
Valves
7
8
9
Piping & Insulation
10
11
12
Temperature Control
13
14
15
Leaks & Drips
16
17
18
Are there any observed safety hazards?
*
No
Yes (please describe below)
Additional Comments or Recommendations
Upload Photos or Supporting Documents (optional)
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Inspector Signature
*
Submit Inspection
Submit Inspection
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