Attachment 4 - Work Certificate Inventory_W912PB26QA018.pdf

This is a Work Certificate Inventory Record template used for documenting preventive maintenance and repair of equipment under federal contracts.

The form captures essential equipment identification information including inventory number, community location, equipment type, manufacturer and model number, serial number, year of manufacture, and year of installation. It requires contractors to list applicable Contract Line Item Numbers (CLINs) with associated quantities and maintenance frequencies using standardized codes (A=Annual, S=Semiannual, Q=Quarterly, M=Monthly, J=Bi-Monthly, W=Weekly, B=Bi-Weekly, D=Daily). For refrigeration and cooling equipment, the form mandates documentation of refrigerant type, weight in kilograms, Global Warming Potential (GWP), and GWP equivalent tonnage. The form includes mandatory compliance sections for leakage detection system status and cooling agent leakage testing frequency in accordance with EU-VO 517/2014 regulations, with checkboxes for determining whether leaking tests are not required, annual, semiannual, or quarterly. Contractors must also indicate whether a system logbook exists and is current. The form concludes with sections for documenting maintenance performed (referencing specific SOW CLIN numbers and manufacturer manuals), equipment condition remarks, confirmation of inventory label attachment, and signature lines for date, technician name, and inventory acceptance verification.