Form - Quarterly Maintenance Inspection Form

Inspection Period:
           ☐ January ☐ April ☐ July ☐ October
Date of Inspection: ________________________
Inspected By:  ____________________________         Supervisor: ____________________________________

1. Air Conditioning Systems

Task	Completed (Yes/No)	Notes/Issues
Inspect all AC units for proper functioning	☐ Yes ☐ No
Check for unusual noises or leaks	☐ Yes ☐ No
Clean or replace air filters	☐ Yes ☐ No
Ensure thermostat settings are accurate	☐ Yes ☐ No

2. Generator Systems

Task	Completed (Yes/No)	Notes/Issues
Record generator hours	☐ Yes ☐ No	Total hours:
Conduct generator load test	☐ Yes ☐ No
Inspect fuel lines, oil levels, filters	☐ Yes ☐ No
Check for wear or damage on the generator	☐ Yes ☐ No

3. Plumbing Systems

Task	Completed (Yes/No)	Notes/Issues
Inspect bathrooms and kitchens for leaks	☐ Yes ☐ No
Check water heaters for proper operation	☐ Yes ☐ No
Test drainage for blockages	☐ Yes ☐ No

4. Electrical Systems

Task	Completed (Yes/No)	Notes/Issues
Check exterior lights and replace bulbs	☐ Yes ☐ No
Inspect electrical wiring for wear	☐ Yes ☐ No
Test outlets and switches	☐ Yes ☐ No

5. Building Structural Integrity

Task	Completed (Yes/No)	Notes/Issues
Inspect roofs, walls, and foundations for damage	☐ Yes ☐ No
Check doors and windows for smooth operation	☐ Yes ☐ No
Oil tracks/hinges of gates and doors	☐ Yes ☐ No

6. Fire Safety Equipment

Task	Completed (Yes/No)	Notes/Issues
Inspect fire extinguishers	☐ Yes ☐ No
Test smoke detectors and alarms	☐ Yes ☐ No

7. Water Treatment Systems

Task	Completed (Yes/No)	Notes/Issues
Check water tanks and treatment chemicals	☐ Yes ☐ No
Inspect piping for leaks or weaknesses	☐ Yes ☐ No

8. Insect and Pest Control

Task	Completed (Yes/No)	Notes/Issues
Inspect for signs of pest infestation	☐ Yes ☐ No
Ensure insecticide treatment is applied	☐ Yes ☐ No

9. Landscaping and Exterior Areas

Task	Completed (Yes/No)	Notes/Issues
Inspect grounds for overgrowth and hazards	☐ Yes ☐ No
Check walkways for trip hazards	☐ Yes ☐ No

10. Water Jug Supply

Task	Completed (Yes/No)	Notes/Issues
Confirm water jugs placed on back porches	☐ Yes ☐ No
Collect and replace empty water jugs	☐ Yes ☐ No

Comments/Additional Issues:
Please provide any additional details or issues that were identified during the inspection.
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________

Inspector Signature: ____________________                     Supervisor Review Signature: ____________________

Date Submitted: ____________________