Chemical Dosing System Maintenance Checklist Form
Log and track routine maintenance checks for your chemical dosing system. Complete all sections to ensure thorough documentation.
Date of Maintenance Check
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name of Technician
*
First Name
Last Name
System Location or ID
*
Pre-Check: Confirm system is powered off before inspection
*
Yes
No
Visual Inspection: Check for leaks, corrosion, or damage
*
No leaks detected
No corrosion observed
No visible damage
Other (specify below)
Pump Operation: Test and confirm pump is functioning correctly
*
Operational
Not operational
Check dosing lines and connections for blockages or wear
*
All clear
Blockage found
Wear detected
Inspect chemical supply levels and refill if necessary
*
Sufficient
Refilled
Not required
Were any issues found during this maintenance check?
*
Yes
No
Comments or Actions Taken
Submit Maintenance Log
Should be Empty: