A/C Refrigerant Discharge Hose Inspection Checklist
Complete this checklist to assess the condition and compliance of the A/C refrigerant discharge hose.
Inspector Name
*
First Name
Last Name
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hose Identification / Serial Number
*
Visual Condition of Hose
*
Excellent
Good
Fair
Poor
Leak Check
*
No leaks detected
Minor leak observed
Major leak observed
Fittings and Connections Secure
*
All secure
Some loose
Needs attention
Physical Damage Assessment
*
Cracks
Bulges
Cuts
Abrasion
None
Cleanliness of Hose
*
Clean
Dirty
Contaminated
Inspection Matrix: Hose Condition by Section
*
Rows
No Defects
Minor Defects
Major Defects
Hose Body
1
2
3
Fittings
4
5
6
Clamps
7
8
9
Protective Covering
10
11
12
Compliance with Specifications
*
Compliant
Non-compliant
Requires further review
Defects or Observations Notes
Overall Condition Rating
*
1
2
3
4
5
Inspection Complete?
*
Yes
No
Submit Checklist
Should be Empty: