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Cooling Name Model

Client Info

First

Last

Phone Number

Address

Address Line 1

Address Line 2

City

State

Zip Code

Date (MM/DD/YYYY)

Technician Name

First

Last

System Type

Make

Tonnage

Age

Outdoor Unit Checklist

Compressor
Fan Blades
Capacitors
Contactor Good
Filter Drier

Indoor Unit Checklist

Evaporator Clean/Clear
Blower Motor Clean
Air Leaks at Unit/Plenum
Drain Blowout/Cleaner
Duct Work Connections
Area Around Unit Clear

Model Number

Click or drag a file to this area to upload.

Serial Number

Click or drag a file to this area to upload.

TD Performance Readings

Cooling Test/Heat Pump Heating Test