Shaft Seal Maintenance Checklist Form
Use this form to record shaft seal inspections, maintenance findings, corrective actions, and follow-up needs.
Maintenance Identification
Maintenance Date
*
-
Month
-
Day
Year
Date
Equipment or Asset ID
*
Shaft Seal Location or Assembly Name
*
Maintenance Type
*
Routine Inspection
Preventive Maintenance
Corrective Maintenance
Post-Repair Verification
Technician or Operator Name
*
Inspection and Condition Checklist
Seal Condition Status
*
Good
Minor wear
Needs attention
Failed
Visible Leakage Present
*
Yes
No
Leakage Severity
None
Slight
Moderate
Severe
Lubrication Condition
*
Adequate
Low
Contaminated
Not applicable
Vibration or Noise Observed
*
Yes
No
Surrounding Contamination or Corrosion Condition
*
None
Light
Moderate
Heavy
Actions and Follow-Up
Corrective Actions Performed
*
Parts Replaced or Materials Used
Status After Maintenance
*
Returned to Service
Monitor Closely
Requires Further Repair
Removed from Service
Next Inspection Due Date / Follow-Up Date
-
Month
-
Day
Year
Date
Technician Notes or Recommendations
Submit
Should be Empty: