Refrigerant Discharge Hose Inspection Form
Please complete all sections to document the inspection of the refrigerant discharge hose. Use this form to record identification details, inspection results, and any required follow-up actions.
Date of Inspection
*
-
Month
-
Day
Year
Date
Inspector Name
*
First Name
Last Name
Hose Serial Number or Asset ID
*
Location of Hose
*
Visual Condition of Hose
*
Good
Minor Wear
Cracks or Abrasion
Bulges or Blisters
Other
Signs of Leakage
*
No Leakage Detected
Leakage Present
Fittings and Connections Condition
*
Secure and Intact
Loose or Damaged
Hose Support and Routing
*
Properly Supported
Improper Routing/Support
Inspection Result
*
Pass
Fail
Follow-up Actions or Recommendations
Submit Inspection
Should be Empty: