EMR_2019_Attachment_9_-_Inventory_Record.pdf
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- Emergency Maintenance and Repair of HVAC Systems
- Solicitation number
- W912PB19R3000
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Inventory Record
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ATTACHMENT 9 - Work Certificate Inventory Record (Name Contractor)
O SEMIANNUAL LEAKING TEST OF REFRIGERATION SYSTEM
Frequency of Cooling Agent Leaking Test (According EU-VO 517/2014)
DATE
TECHNICIAN
INVENTORY ACCEPTED
TYPE OF REFRIGERANT: WEIGHT OF REFRIGERANT CONTENT IN KG:
GLOBAL WARMING POTENTIAL (GWP): TONS GWP ÄQUIVALENT:
(List numbers of maintenance steps performed as descripted in SOW CLIN
O ANNUAL LEAKING TEST OF REFRIGERATION SYSTEM O ESTABLISH SYSTEM LOGBOOK IF NOT PRESENT and/or information on maintenance performed IAW manufacturer's manual)
LOCATION, BUILDING #:LEAKAGE DETECTION SYSTEM EXISTING: O YES O NO
O LEAKING TEST OF REFRIGERATION SYSTEM IS NOT REQUIRED O IF NECCESARY, IS A SYSTEM LOGBOOK EXISTING
MAINTENANCE PERFORMED :
REMARKS : (EQUIPMENT CONDITION REPORT)
O ALL ENTRIES IN SYSTEM LOGBOOK ARE UP TO DATE
CLIN'S
Frequency
O QUARTERLY LEAKING TEST OF REFRIGERATION SYSTEM
INVENTORY RECORD
PREVENTIVE MAINTENANCE AND REPAIR OF VENTILATION, AIR CONDITIONING, REFRIGERATOR / FREEZER AND OTHER EQUIPMENT
INVENTORY NUMBER: COMMUNITY:
CLIN No. Quantity Maintenance Quantity MaintenanceCLIN No.
Frequency
MANUFACTURER SERIAL #: YEAR OF INSTALLATION:
YEAR OF MANUFACTURED: OTHER EQUIPMENT SPECIFICATION:
A = Annual S = Semiannual Q = Quarterly M = Monthly J = Bi-Monthly W = Weekly B = Bi-Weekly D = Daily
EQUIPMENT TYPE: MANUFACTURER & MODEL #:
EMR 2019_Attachment 9 - Inventory Record.xlsx
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