Pump Condition Monitoring Checklist Form
Complete this checklist during routine pump inspections to assess the current condition and identify any maintenance needs.
Inspector Name
*
First Name
Last Name
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Pump Identification/Number
*
Visual Condition of Pump
*
Good
Fair
Poor
Vibration Level
*
1
2
3
4
5
Noise Level
*
1
2
3
4
5
Temperature (Surface/Operating)
*
Leakage Observed
*
No Leakage
Minor Leakage
Major Leakage
Lubrication Status
*
Adequate
Needs Replenishment
Not Applicable
Additional Comments or Observations
Submit Checklist
Should be Empty: