Air Conditioner Capacitor Discharge Safety Checklist Form
Complete this checklist to document all required safety steps before servicing an air conditioner capacitor. Ensure each item is verified for technician and equipment safety.
Technician Full Name
*
First Name
Last Name
Date of Service
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Air Conditioner Unit ID or Location
*
Personal Protective Equipment (PPE) Worn
*
Safety glasses
Insulated gloves
Protective clothing
Power to Unit Confirmed OFF and Locked Out
*
Yes
No
Capacitor Discharge Tool Ready and Inspected
*
Yes
No
Voltage Verified at Capacitor Terminals (Zero Voltage)
*
Yes
No
Area Cleared of Unauthorized Personnel
*
Yes
No
Visual Inspection for Damage or Hazards Completed
*
Yes
No
Checklist Completed and Ready for Discharge Procedure
*
Yes, all steps completed
No, steps remain
Submit Checklist
Should be Empty: