AC Heat Pump Observation Checklist
Document and assess the condition and performance of an AC heat pump system during inspection.
Date of Observation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Location of Inspection
*
Inspector Name
*
First Name
Last Name
Heat Pump Make and Model
*
Serial Number (if available)
System Power Status
*
On
Off
Intermittent
Other
Thermostat Operation
*
Operating Normally
Malfunctioning
Not Tested
Other
Airflow Condition
*
Strong
Adequate
Weak
No Airflow
Cooling/Heating Performance Rating
*
1
2
3
4
5
Checklist of Observed Issues or Actions
Unusual noises
Leaks (water or refrigerant)
Dirty filters
Blocked vents
Corrosion or rust
Worn belts or parts
None observed
Other (specify)
Recommended Maintenance or Actions Needed
Additional Comments or Observations
Inspector Signature
*
Submit Checklist
Submit Checklist
Should be Empty: