Preventive Maintenance Pump Service Report
Fill in the service details, alignment/vibration results, material usage, and complete the relevant item checklist.
Report Details
Report Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Equipment
*
Please Select
Please Select
Start Time
*
Hour Minutes
AM
PM
AM/PM Option
Finish Time
*
Hour Minutes
AM
PM
AM/PM Option
Service Identification
Service Identification
*
Material Usage
Spare Parts Usage
Work Completion
Vertical Offset (mm)
*
Horizontal Offset (mm)
*
Vertical Angular (mm)
*
Horizontal Angular (mm)
*
Vibration (mm/s)
*
Housekeeping
Good
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Item Checklist - General Pump
General Pump Item Checklist
*
Rows
Condition
Impeller
Shaft
Casing
Mechanical Seal + Bellow
Strainer
Oil / Grease
Rubber Coupling / Belt
Bellows Mechanical Seal
Gasket
Bearing
Gland Packing / Oring
Baik
Condition
Impeller Condition
Good
Fair
Poor
Other
Shaft Condition
Good
Fair
Poor
Other
Casing Condition
Good
Fair
Poor
Other
Mechanical Seal + Bellow Condition
Good
Fair
Poor
Other
Strainer Condition
Good
Fair
Poor
Other
Oil / Grease Condition
Good
Fair
Poor
Other
Rubber Coupling / Belt Condition
Good
Fair
Poor
Other
Bellows Mechanical Seal Condition
Good
Fair
Poor
Other
Item Checklist - B.
Rows
Condition
Impeller
Shaft / Rotor
Casing
Stator
Bearing spiral groove
Bearing straight and spiral groove
Gland Packing / Oring
Heat Exchanger
TRG
Item Checklist - C.
Item Checklist
*
Rows
Condition
Impeller
Shaft
Casing
Mechanical Seal + Bellow
Strainer
Oil / Grease
Rubber Coupling / Belt
Bellows Mechanical Seal
Gasket
Bearing
Gland Packing / Oring
Item Checklist - D
*
Rows
Condition
Casing
Mechanical Seal
Pulley / Belting
Oil / Grease
Rubber Coupling / Belt
Gasket
Bearing
Gland Packing / Oring
Casing Condition
Good
Needs Attention
Mechanical Seal Condition
Good
Needs Attention
Pulley / Belting Condition
Good
Needs Attention
Oil / Grease Condition
Good
Needs Attention
Rubber Coupling / Belt Condition
Good
Needs Attention
Gasket Condition
Good
Needs Attention
Bearing Condition
Good
Needs Attention
Item Checklist - E.
Rows
Baik
Condition
Impeller
1
2
Shaft
3
4
Casing
5
6
Mechanical Seal + Bellow
7
8
Strainer
9
10
Oil / Grease
11
12
Rubber Coupling / Belt
13
14
Bellows Mechanical Seal
15
16
Gasket
17
18
Bearing
19
20
Gland Packing / Oring
21
22
Item Checklist - F.
*
Rows
Condition
Rotor
Stator
Gearbox
Strainer
Oil / Grease
Rubber Coupling
Gasket
Bearing
Submit
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