Equipment Condition Monitoring Retrofit Assessment Form
Use this form to evaluate the condition of equipment and determine retrofit readiness, monitoring needs, and project priorities.
Site and Equipment Overview
Site Name
*
Site Location
*
Equipment Asset Tag or Identifier
*
Equipment Type
*
Please Select
Pump
Motor
Compressor
HVAC Unit
Conveyor
Panel
Other
Manufacturer / Model
Current Age / Installation Year
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Condition Assessment
Overall Condition Rating
*
1
2
3
4
5
Operating Reliability
*
Very Poor
1
2
3
4
Very Good
5
1 is Very Poor, 5 is Very Good
Visible Wear / Corrosion / Vibration / Noise
*
Rows
None
Minor
Moderate
Severe
Wear
1
2
3
4
Corrosion
5
6
7
8
Vibration
9
10
11
12
Noise
13
14
15
16
Downtime Frequency
*
Please Select
Never
Rarely
Occasionally
Monthly
Weekly
Daily
Other
Maintenance History Quality
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Retrofit Readiness and Requirements
Retrofit Priority Level
*
Low
Medium
High
Urgent
Desired Retrofit Objectives
*
Energy reduction
Reliability improvement
Condition monitoring
Predictive maintenance
Compliance/supportability
Other
Existing Monitoring Systems Present
*
None
Basic local indicators
SCADA/BMS integration
Condition monitoring system
Other
Required Data Points / Sensors
*
Site Constraints or Access Limitations
Preferred Implementation Timeline
*
Immediate
Within 1-3 months
Within 3-6 months
Within 6-12 months
Flexible / To be scheduled
Other
Submit Assessment
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