Preventative Maintenance Eval Form Use this for PM Evaluation CompanyDate Date Format: MM slash DD slash YYYY Time : HH MM AMPM 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 Section BreakAccessibility*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 installationSection BreakLoad DensityMeasurements to creat Heat Load CalculationHours Required for service*Parts List*MakeModelSerialFilter Size & QtyBelt Size & QtyCompressor QtyLocation of UnitDist. of Inside & Out Special ConsiderationAnything not listed on form but pertinent to jobFile UploadPicture, Drawings, anything pertinent to be reiviewedCAPTCHAEmailThis field is for validation purposes and should be left unchanged.
