Gearbox Oil Analysis Report Form
Use this form to record gearbox oil sample details, lab results, inspection observations, and recommended maintenance actions.
Equipment and Sample Identification
Equipment Name / Asset ID
*
Gearbox Model / Type
*
Site / Location
*
Sample ID
*
Sample Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Sample Time
Hour Minutes
AM
PM
AM/PM Option
Operating Hours / Kilometers Since Last Oil Change
Sampler Name / Department
*
Lubricant and Operating Details
Oil Brand
Oil Type / Grade
*
Please Select
Synthetic
Semi-Synthetic
Mineral
Blended
Other
Oil Specification
Was the oil changed or topped up recently?
*
Yes
No
Date of Last Oil Change
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current Operating Temperature Range
Please Select
Below 60°C
60–80°C
81–100°C
101–120°C
Above 120°C
Other
Duty Cycle / Operating Load
Please Select
Light
Normal
Heavy
Severe
Variable
Other
Recent Abnormal Operating Events
Laboratory Analysis Results
Viscosity Result
*
Water Content
*
Particle Count
*
Acidity / TAN
*
Wear Metal Reading
Oxidation Level
*
Normal
Slightly Elevated
Elevated
Severe
Other
Contamination Level
*
Low
1
2
3
4
5
6
7
8
9
High
10
1 is Low, 10 is High
Multiple Contaminants / Wear Metals
Rows
Measured Value
Unit
Status
Iron
1
2
3
Copper
4
5
6
Lead
7
8
9
Silicon
10
11
12
Soot
13
14
15
Water
16
17
18
Other Contaminant
19
20
21
Visual Inspection and Condition Indicators
Oil Color
*
Amber
Dark Brown
Black
Milky
Reddish
Other
Odor
Normal
Burnt
Sour
Chemical
Strong Petroleum
Other
Visible Condition Indicators
*
Sludge
Varnish
Foam
Visible Debris
Metal Sheen
Emulsion Signs
Severity of Contamination or Wear
*
1
2
3
4
5
Additional Observations or Anomalies
Visible Debris Type
Fine Particles
Fibers
Chips
Flakes
Other
Emulsion or Water Contamination Signs
Cloudiness
Free Water
Water Droplets
Creamy Appearance
None Observed
Maintenance Action and Reporting
Analysis Outcome
*
Normal
Monitor
Schedule Service
Urgent Action
Recommended Follow-Up Action
*
Please Select
Continue Operation
Increase Monitoring
Schedule Inspection
Replace Oil
Inspect Gearbox
Other
Priority Level
*
Low
Medium
High
Critical
Next Inspection or Retest Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Analyst Comments and Recommended Maintenance Steps
*
Reviewer / Approver Name
Submit Report
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