EVALUATION FORM Preventative Maintenance Eval Form Use this for PM Evaluation CompanyDate MM slash DD slash YYYYTime : Hours Minutes AM PM AM/PMContact Person* First Last Authorizing Person (Owner, Manager, Supervisor)Address* Site Identification (state where the unit is located) Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Accessibility*Steps required to physcially work on unit.Location of AH (Inside) UnitLocation of Condenser (Outside) UnitDistance Between Units*Measured Amount of feet and inches between Inside and Outside UnitConstraintsRoof PenetrationElectrical ClearanceVoltage*Air HandlerVoltageCondenserEquipmentEquipment and Tool Rental anticipated to complete installationLoad DensityMeasurements to creat Heat Load CalculationHours Required for service*Parts List*MakeModelSerialFilter Size & QtyBelt Size & QtyCompressor QtyLocation of UnitDist. of Inside & Out Compressor Model / Serial Number*Compressor Model / Serial Number*Special ConsiderationAnything not listed on form but pertinent to jobFile UploadMax. file size: 256 MB.Picture, Drawings, anything pertinent to be reiviewedCAPTCHACommentsThis field is for validation purposes and should be left unchanged.Δ
EVALUATION FORM