Preventive maintenance checklist template

A blank preventive maintenance checklist to print. You write the items from your equipment manual; the form gives every check the same layout and a result for each item.

What this form is

It is a blank preventive maintenance checklist on one page: the equipment at the top, fifteen numbered lines for the items to check, and three boxes on each line for the result: OK, Needs attention or N/A.

The lines are empty on purpose. The items to check are different for every machine, and they belong in the manufacturer's manual and your site's procedures, not in a general template.

What each part is for

• Asset, Asset ID and Location: which piece of equipment was checked.
• Date and Checked by: when the check was done and by whom.
• Items taken from: the manual or procedure the items were copied from, with its version or date if it has one. It tells the next reader where the list came from.
• Item to check: one item per line, written so another person can tell whether it was checked.
• OK, Needs attention, N/A: tick one box per item.
• Notes: what was found, especially for items marked Needs attention.
• Signature and date: who confirms the check was done.

How to build your checklist

1. Open the manufacturer's manual for the machine and find its maintenance section.
2. Copy each inspection item onto its own line, in the order the manual gives. Do not add or remove steps on your own judgment; ask someone qualified if the manual is unclear.
3. Add any checks your site's procedures require.
4. Print one master copy with the items written in, and photocopy it for each check.
5. After each check, attach the completed checklist to the job's work order or note the result in the maintenance log.

Limits

• This site does not provide the items. It does not publish maintenance tasks or intervals for any machine.
• A checklist is a record, not a certificate. It documents what was checked; it does not certify that equipment is safe to use.
• It is not a safety procedure. Work on equipment with stored energy needs procedures and training of its own.

Next steps

• The work order generator has an inspection checklist section with the same three results, if you prefer to type the items once and print them.
• Plan when each check is due with the preventive maintenance schedule template.
• Read how to make a preventive maintenance schedule.