9/30/23, 1:07 PM Chiller Plant Preventive Maintenance Schedule Checklist - SafetyCulture

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Title Page

Facility Name

Facility Location 

Inspected by

Conducted on 

Preventive Maintenance Schedule Checklist

Select Preventive Maintenance Schedule

Weekly Monthly

Chiller

Chiller Name/ID

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9/30/23, 1:07 PM Chiller Plant Preventive Maintenance Schedule Checklist - SafetyCulture

Location in Cooling Plant

Chiller Type

Centrifugal Screw Reciprocating Absorption Other

Specify

General Condition

OK Not OK N/A

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Excessive Noise or Vibration

OK Not OK N/A

Take photos and add notes to describe the issue 

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9/30/23, 1:07 PM Chiller Plant Preventive Maintenance Schedule Checklist - SafetyCulture

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Temperature Readings

OK Not OK N/A

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Motor

OK Not OK N/A

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

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9/30/23, 1:07 PM Chiller Plant Preventive Maintenance Schedule Checklist - SafetyCulture

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Refrigerant Level

OK Not OK N/A

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Refrigerant System

OK Not OK N/A

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

https://public-library.safetyculture.io/products/chiller-plant-preventive-maintenance-schedule-checklist?amp_dev=9949af58-0e69-415f-b79d-848… 4/19
9/30/23, 1:07 PM Chiller Plant Preventive Maintenance Schedule Checklist - SafetyCulture

Purge System Operation

OK Not OK N/A

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Purge Cycle Counter Reading

OK Not OK N/A

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Water Treatment System Operation

OK Not OK N/A

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9/30/23, 1:07 PM Chiller Plant Preventive Maintenance Schedule Checklist - SafetyCulture

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Motor

OK Not OK N/A

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Refrigerant Level

OK Not OK N/A

Take photos and add notes to describe the issue 

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9/30/23, 1:07 PM Chiller Plant Preventive Maintenance Schedule Checklist - SafetyCulture

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Refrigerant System

OK Not OK N/A

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Water Treatment System Operation

OK Not OK N/A

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

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9/30/23, 1:07 PM Chiller Plant Preventive Maintenance Schedule Checklist - SafetyCulture

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Oil Color

OK Not OK N/A

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Refrigerant Level

OK Not OK N/A

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

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9/30/23, 1:07 PM Chiller Plant Preventive Maintenance Schedule Checklist - SafetyCulture

Refrigerant System

OK Not OK N/A

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Belts and Coupling Alignment

OK Not OK N/A

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Purge Unit Operation

OK Not OK N/A

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9/30/23, 1:07 PM Chiller Plant Preventive Maintenance Schedule Checklist - SafetyCulture

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Purge Unit Belt

OK Not OK N/A

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Solution Pump Motor

OK Not OK N/A

Take photos and add notes to describe the issue 

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9/30/23, 1:07 PM Chiller Plant Preventive Maintenance Schedule Checklist - SafetyCulture

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Chiller

Chiller Type

Centrifugal Screw Reciprocating Absorption Other

Specify

General Condition

OK Not OK N/A

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

https://public-library.safetyculture.io/products/chiller-plant-preventive-maintenance-schedule-checklist?amp_dev=9949af58-0e69-415f-b79d-84… 11/19
9/30/23, 1:07 PM Chiller Plant Preventive Maintenance Schedule Checklist - SafetyCulture

Excessive Noise or Vibration

OK Not OK N/A

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Temperature Readings

OK Not OK N/A

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

All Valves

OK Not OK N/A

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9/30/23, 1:07 PM Chiller Plant Preventive Maintenance Schedule Checklist - SafetyCulture

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Control System Settings and Operation

OK Not OK N/A

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Filters and Strainers

OK Not OK N/A

Take photos and add notes to describe the issue 

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9/30/23, 1:07 PM Chiller Plant Preventive Maintenance Schedule Checklist - SafetyCulture

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

All Valves

OK Not OK N/A

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Pump Seals

OK Not OK N/A

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

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9/30/23, 1:07 PM Chiller Plant Preventive Maintenance Schedule Checklist - SafetyCulture

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Control System Settings and Operation

OK Not OK N/A

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Filters

OK Not OK N/A

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

https://public-library.safetyculture.io/products/chiller-plant-preventive-maintenance-schedule-checklist?amp_dev=9949af58-0e69-415f-b79d-84… 15/19
9/30/23, 1:07 PM Chiller Plant Preventive Maintenance Schedule Checklist - SafetyCulture

Vibration Isolators

OK Not OK N/A

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Control System Settings and Operation

OK Not OK N/A

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Cycle Controls and Unloaders Operation

OK Not OK N/A

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9/30/23, 1:07 PM Chiller Plant Preventive Maintenance Schedule Checklist - SafetyCulture

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Crankcase Heaters

OK Not OK N/A

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Safety Control Settings

OK Not OK N/A

Take photos and add notes to describe the issue 

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9/30/23, 1:07 PM Chiller Plant Preventive Maintenance Schedule Checklist - SafetyCulture

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Lubricating Pump Line Strainers

OK Not OK N/A

Take photos and add notes to describe the issue 

Can I repair this now?

Yes No

Take photos and add notes to describe the work


done

Create an action and assign it with the necessary details, priority level, and due date.

Sign Off

Additional Recommendations

Inspector Name & Signature 

Plant Supervisor Name & Signature 

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9/30/23, 1:07 PM Chiller Plant Preventive Maintenance Schedule Checklist - SafetyCulture

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