EVALUATION FORM Preventative Maintenance Eval Form Use this for PM Evaluation CompanyDate Date Format: MM slash DD slash YYYY Time : HH MM AM PM Contact Person* First Last Authorizing Person (Owner, Manager, Supervisor)Address* Site Identification (state where the unit is located) Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest 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 HandlerVoltageCondenser EquipmentEquipment 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 UploadPicture, Drawings, anything pertinent to be reiviewedCAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
EVALUATION FORM