PREVENTIVE MAINTENANCE CHECKLIST

Company Name: ___
Work Order #: ___
Equipment ID.: ___
Date: ___
SOP No.: ___
Performed By: ___
SOP Effective Date: / /
Reviewed By Client: ___

Section Complete Check & Initials

6 SAFETY - Check the step performed ___ Level(1)

☐ 6.1 ☐ 6.2 ☐ 6.3 ☐ 6.4 ☐ 6.5 ☐ ___

11 MONTHLY - Check the step performed ___ Level(1)

☐ 11.1 ☐ 11.2 ☐ 11.3 ☐ 11.4 ☐ 11.5 ☐ 11.6
☐ 11.7 ☐ 11.8 ☐ 11.9 ☐ 11.10 ☐ 11.11 ☐ 11.12 ☐ ___

10 QUARTERLY - Check the step performed ___ Level(1)

☐ 10.1 ☐ 10.2 ☐ 10.3 ☐ 10.4 ☐ 10.5 ☐ 10.6
☐ 10.7 ☐ 10.8 ☐ 10.9 ☐ 10.10 ☐ 10.11 ☐ 10.12 ☐ ___

9 SEMIANNUAL - Check the step performed ___ Level(1)

☐ 9.1 ☐ 9.2 ☐ 9.3 ☐ 9.4 ☐ 9.5 ☐ 9.6
☐ 9.7 ☐ 9.8 ☐ 9.9 ☐ 9.10 ☐ 9.11 ☐ 9.12 ☐ ___

8 ANNUAL - Check the step performed ___ Level(1)

☐ 8.1 ☐ 8.2 ☐ 8.3 ☐ 8.4 ☐ 8.5 ☐ 8.6 ☐ 8.7
☐ 8.8 ☐ 8.9 ☐ 8.10 ☐ 8.11 ☐ 8.12 ☐ 8.13 ☐ 8.14 ☐ ___

Make entry in Equipment Maintenance Log, Form 8.001.1.

Completion: Does this SOP accurately and adequately describe the correct maintenance requirements of this equipment? Yes ___ No ___ If NOT, please explain:

Note: (1) = Enter the highest step number in each section performed

Rev. 1 FN: 8.001.6