Chiller Equipment Survey Form
Please complete this form to document the inspection and condition of chiller equipment at your site.
Site Name or Location
*
Chiller Equipment ID/Tag
*
Chiller Type
*
Air-Cooled
Water-Cooled
Absorption
Other
Manufacturer and Model
*
Year of Manufacture
*
Overall Equipment Condition
*
1
2
3
4
5
Current Operating Status
*
Operational
Under Maintenance
Not Operational
Decommissioned
Observed Issues / Defects
Leaks
Unusual Noise
Corrosion
Electrical Fault
None Observed
Other
Maintenance History (Last 3 Years)
Rows
Year
Major Service Performed
1
2
3
Technician Notes / Recommendations
Submit Survey
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