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. Toilet and Plumbing Systems
| Task | Completed (Yes/No) | Notes/Issues |
|---|---|---|
| Check all toilets for proper flushing and water pressure | ☐ Yes ☐ No | |
| Inspect toilet tanks and handles for leaks or malfunctions | ☐ Yes ☐ No | |
| Check faucets in bathrooms and kitchens for leaks or drips | ☐ Yes ☐ No | |
| Inspect showers and bathing areas for proper water flow and drainage | ☐ Yes ☐ No | |
| Check water heaters for proper operation | ||
| ☐ 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.
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Inspector Signature: ____________________ Supervisor Review Signature: ____________________
Date Submitted: ____________________