HVAC System Maintenance - Patient Care Areas Checklist
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This Template was installed 3 times.
General System Overview & Documentation
Initial assessment and verification of documentation for all HVAC equipment in patient care areas.
Last System Performance Review Date
System Serial Number(s)
Brief Description of Current System Configuration
System Type (e.g., VAV, RTU, VRF)
System Operational Status
Upload Current System Schematics (if available)
Contact Person for HVAC System Information
Total System Capacity (BTU/hr)
Air Filtration & Ventilation
Focuses on filter maintenance, air quality, and proper ventilation in patient care environments.
Filter Change Date
Filter Type
Air Exchange Rate (ACH)
Exhaust Fan Operation
Notes on Air Quality/Ventilation
Ventilation Issues Observed
Last Duct Cleaning Date
Temperature & Humidity Control
Ensures comfortable and appropriate temperature and humidity levels within patient care areas.
Ambient Temperature (Degrees F)
Supply Air Temperature (Degrees F)
Return Air Temperature (Degrees F)
Relative Humidity (%)
Thermostat Mode (Cool/Heat/Auto/Off)
Dew Point Setting (if applicable)
Notes on Temperature/Humidity Control
Last Calibration Date (Thermostat/Sensors)
Equipment Performance & Safety
Covers the functional operation of HVAC equipment and addresses safety concerns.
Supply Air Temperature (Patient Zone 1) - °F
Return Air Temperature (Patient Zone 1) - °F
Static Pressure (Supply Duct) - Inches of Water
Equipment Condition (e.g., Excellent, Good, Fair, Poor)
Visible Signs of Leaks (Refrigerant, Water)
Any unusual noises or vibrations observed?
Safety Guarding Intact and Secure?
Date of Last Belt Inspection/Replacement
Noise & Vibration
Addresses noise and vibration levels to maintain a peaceful environment for patients.
Sound Level (dB) at Patient Bed
Vibration Measurement (mm/s) - Equipment Base
Describe any unusual noises observed (e.g., humming, rattling)
If 'Other' noise selected, please describe:
Is vibration noticeable to patients/staff?
Notes on vibration reduction measures taken (if any):
Date of last vibration/noise mitigation work:
Airflow & Distribution
Verifies proper airflow patterns and distribution throughout patient care areas.
Supply Air Volume (CFM) - Verify setpoint & reading
Return Air Volume (CFM) - Verify setpoint & reading
Airflow Direction - Correct?
Air Outlets - Free of Obstructions?
Areas with Airflow Concerns?
Notes/Comments on Airflow Distribution
Location of Airflow Issues (if any)
Emergency & Backup Systems
Confirms functionality of emergency backup systems and protocols.
Last Generator Test Date
Generator Run Time (Hours)
Generator Status
Emergency Power Transfer Switch Status
Last Battery System Inspection Date
Battery Voltage (Volts)
Comments/Observations regarding Emergency Systems
Verification of Emergency Contact List Availability
Facility Management Solution Screen Recording
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