Progressive Cavity Pump Maintenance Checklist Form
Complete this form to record inspection and maintenance details for a progressive cavity pump.
Equipment Identification Number
*
Date of Maintenance Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector/Technician Name
*
First Name
Last Name
Pump Operating Hours (since last maintenance)
*
Stator Condition
*
Good
Worn
Damaged
Not Inspected
Rotor Condition
*
Good
Worn
Corroded
Not Inspected
Seal Condition
*
Good
Leaking
Worn
Not Inspected
Bearing Condition
*
Good
Noisy
Worn
Not Inspected
Issues Found (if any)
Corrective Actions or Parts Replaced
Overall Maintenance Outcome
*
Passed - Pump in Good Working Condition
Passed with Recommendations
Requires Immediate Attention
Failed - Pump Out of Service
Submit Maintenance Report
Should be Empty: