Door 2019 Attachment 4 - Work Certificate Inventory mod 20191017.pdf
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- M&R Safety Inspection of Doors
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- W912PB20Q3004
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ATTACHMENT 4 - Work Certificate Inventory Record (Name Contractor)
INVENTORY RECORD
PREVENTIVE MAINTENANCE AND REPAIR OF: "TYPE OF EQUIPMENT"
INVENTORY NUMBER: COMMUNITY:
CLIN'S
CLIN No. Quantity Maintenance Frequency
CLIN No. Quantity Maintenance Frequency
A = Annual S = Semiannual Q = Quarterly M = Monthly
J = Bi-Monthly W = Weekly B = Bi-Weekly D = Daily
EQUIPMENT TYPE: MANUFACTURER & MODEL #:
MANUFACTURER SERIAL #: YEAR OF INSTALLATION:
YEAR OF MANUFACTURE: OTHER EQUIPMENT SPECIFICATION:
TYPE OF REFRIGERANT: WEIGHT OF REFRIGERANT CONTENT IN KG:
GLOBAL WARMING POTENTIAL (GWP): TONS GWP ÄQUIVALENT:
LEAKAGE DETECTION SYSTEM EXISTING: O YES O NO LOCATION, BUILDING #:
Frequency of Cooling Agent Leaking Test (According EU-VO 517/2014)
O LEAKING TEST OF REFRIGERATION SYSTEM IS NOT REQUI O IF NECCESARY, IS A SYSTEM LOGBOOK EXISTING
O ANNUAL LEAKING TEST OF REFRIGERATION SYSTEM O ESTABLISH SYSTEM LOGBOOK IF NOT PRESENT
O SEMIANNUAL LEAKING TEST OF REFRIGERATION SYSTEM O ALL ENTRIES IN SYSTEM LOGBOOK ARE UP TO DATE
O QUARTERLY LEAKING TEST OF REFRIGERATION SYSTEM
(List numbers of maintenance steps performed as descripted in SOW CLIN
MAINTENANCE PERFORMED : and/or information on maintenance performed IAW manufacturer's manual)
REMARKS : (EQUIPMENT CONDITION REPORT)
Inventory Label attached: Yes No
DATE TECHNICIAN INVENTORY ACCEPTED
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