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It captures work order details, equipment data, refrigerant type and quantities recovered and added, and service description categories such as major/non-major maintenance, disposal, and leak-related actions. The form records leak findings and verification test dates and methods, plus optional trace gas or accidental release information when applicable, and includes internal supervisor entry and database/initial fields.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/refrigerant-service-order-form-hvac-leak-service-checklist-fill-out-for-each-service/338974/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/refrigerant-service-order-form-hvac-leak-service-checklist-fill-out-for-each-service/338974.png","ImageObject",442,249,{"name":88,"@type":89},"\tWilliam","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-26","2026-09-21",true,{"@type":98,"interactionType":99,"userInteractionCount":73},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What information must be completed for each service where refrigerant transfer occurs?","Question",{"text":108,"@type":109},"All form fields must be completed legibly for each service, and a separate form is required for each circuit involved in the refrigerant transfer.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"Which sections document leak activities and verification testing?",{"text":113,"@type":109},"The form’s Leak Information section records leak found and leak repaired dates, initial leak verification test details, and final leak verification test dates, including the method and whether the test is after repair before charging or under normal load.",{"name":115,"@type":106,"acceptedAnswer":116},"When should the trace gas and accidental release sections be used?",{"text":117,"@type":109},"Use the trace gas section only if trace gas is used, and use the accidental release section only if a refrigerant release occurs accidentally and is not due to mechanical failure, including the reason in the description area.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},338974,1790457399,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":73,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":76,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":9},5909887254083,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","REFRIGERANT SERVICE ORDER FORM  \nTO BE FILLED OUT FOR EVERY SERVICE WHERE REFRIGERANT TRANSFER WILL OCCUR LEGIBLY FILL OUT ALL FIELDS ON FORM FOR EACH SERVICE. FILL OUT A SEPARATE FORM FOR EACH CIRCUIT.  \n\n| Work Order \\#:   Date of Initial Visit:   Date Completed:   Technician: (include printed name & signature)\u003Cbr>Print Name Sign Name |  |  |  |  | Equipment Data\u003Cbr>Building \\#  Specific Location   MHMV  Manufacturer  \u003Cbr>Model \\#\u003Cbr>__________________________________\u003Cbr>Serial \\#   Circuit \\# (if applicable)  Refrigerant Type   FULL CHARGE of System or Circuit being serviced   lb  oz |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- |\n| Service Description (check all that apply):\u003Cbr>􀂆 Major Maintenance\u003Cbr>􀂆 Non-Major Maintenance 􀂆 Other ( Use Svc Desc. Box below) |  |  |  |  |  |  |  |\n| 􀂆 Dispose of Unit 􀂆 Refrigerant Recovered\u003Cbr>􀂆 Unit Disposal Paperwork Completed\u003Cbr>􀂆 Unit Marked “Empty”/Dated |  |  |  |  |  |  |  |\n| 􀂆 Isolated Leak 􀂆 Vacuum Level   |  |  |  |  |  |  |  |\n| 􀂆 Transferred to Receiver/Condenser, or Pump Out Unit\u003Cbr>􀂆 Unit Flat at “0” psi – Could Not Recover |  |  |  |  | Equip Type: 􀂆 Chiller 􀂆 Split Sys 􀂆 Pkg Unit\u003Cbr>􀂆 Lg Freezer 􀂆 Lg Refrig 􀂆 Other  |  |  |\n| Refrigerant | Cylinder Tag ID |  | Refrigerant Type |  |  | Total Quantity Refrigerant Added |  |\n| Recovered |  |  |  |  |  | lbs oz |  |\n|  |  |  |  |  |  | lbs oz |  |\n| Added |  |  |  |  |  | lbs oz |  |\n|  |  |  |  |  |  | lbs oz |  |\n|  |  |  |  |  |  | lbs oz |  |\n|  |  |  |  |  |  | lbs oz |  |\n|  |  |  |  |  |  | lbs oz |  |\n|  |  |  |  |  |  | lbs oz |  |\n|  |  |  |  |  |  | lbs oz |  |\n|  | 􀂆 New Unit Startup Charge TOTAL QUANTITY ADDED: lbs oz |  |  |  |  |  |  |\n| Leak Information\u003Cbr>􀂆 Leak Found\u003Cbr>􀂆 Leak Repaired\u003Cbr>􀂆 Initial Leak Verification Test\u003Cbr>Date \u003Cbr>Date \u003Cbr>Date \u003Cbr>Test done after repair before charging\u003Cbr>Method  \u003Cbr>􀂆 Final Leak Verification Test Date \u003Cbr>Test done with unit running under normal load\u003Cbr>Method   |  |  |  | Leak/Service Description: Mark exact location of leak on diagram and describe how repaired in space below.\u003Cbr>|  |  |  |\n| ONLY FILL THIS SECTION OUT IF TRACE GAS IS USED\u003Cbr>􀂆 Trace Gas Used Ref. Type \u003Cbr>Cylinder ID  \u003Cbr>Quantity   lbs   oz |  |  |  |  |  |  |  |\n| 􀂆 Accidental Release Occurred (ONLY USE THIS SECTION IF A REFRIGERANT RELEASE ACCIDENTALLY OCCURS AND IS NOT DUE TO MECHANICAL FAILURE, INCLUDE REASON FOR RELEASE IN THE DESC. BOX ABOVE) Estimated Quantity   lbs   oz |  |  |  |  |  |  |  |\n| IF YOU RUN OUT OF ROOM ON THIS FORM, ATTACH ADDITIONAL FORM/SHEET. 7MAR2016 |  | HVAC SUPERVISOR OR DESIGNEE ENTRY ONLY |  |  |  |  |  |\n|  |  | Appliance ID   Service Order Form ID  \u003Cbr>􀂆 Entered into Database - Initials   |  |  |  |  | Leak Rate Calculation for unit with >50 lbs Class I/II Refrigerant (e.g. R-22):\u003Cbr>  % |\n\nREFER TO INSTRUCTIONS FOR THE REFRIGERANT SERVICE ORDER FORM  \n\n|  |  | ITEM 1 REFRIGERANT SERVICE ORDER FORM\u003Cbr>TO BE FILLED OUT FOR EVERY SERVICE WHERE REFRIGERANT TRANSFER WILL OCCUR\u003Cbr>LEGIBLY FILL OUT ALL FIELDS ON FORM FOR EACH SERVICE. FILL OUT A SEPARATE FORM FOR EACH CIRCUIT.  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n|  |  | ITEM 2\u003Cbr>Work Order \\#:   Date of Initial Visit:   Date Completed:   Technician: (include printed name & signature)\u003Cbr>Print Name Sign Name |  |  |  |  |  | ITEM 3 Equipment Data\u003Cbr>Building \\#  Specific Location   MHMV  Manufacturer  \u003Cbr>Model \\#\u003Cbr>__________________________________\u003Cbr>Serial \\#   Circuit \\# (if applicable)  Refrigerant Type   FULL CHARGE of System or Circuit being serviced   lb  oz |  |  |  |  |  |  |  |\n|  |  | Service Description (check all that apply):\u003Cbr>􀂆 Major Maintenance\u003Cbr>􀂆 Non-Major Maintenance 􀂆 Other ( Use Svc Desc. Box below) |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  | 􀂆 Dispose of Unit 􀂆 Refrigerant Recovered\u003Cbr>􀂆 Unit Disposal Paperwork Completed\u003Cbr>􀂆 Unit Marked “Empty”/Dated |  |  |  |  |  |  |  |  |  |  ","cbCaiuJeMM3pXEle","https://ap.wps.com/l/cbCaiuJeMM3pXEle","pdf",1209354,"English","# Work Order & Technician\n## Equipment Data\n## Service Description & Unit Disposition\n# Refrigerant Quantity Summary\n## Recovered and Added Amounts\n## Total Quantity Added\n# Leak Information\n## Leak Found/Repair Dates\n## Leak Verification Tests\n# Optional Sections\n## Trace Gas Used\n## Accidental Release\n# Internal Entries","[{\"question\":\"What information must be completed for each service where refrigerant transfer occurs?\",\"answer\":\"All form fields must be completed legibly for each service, and a separate form is required for each circuit involved in the refrigerant transfer.\"},{\"question\":\"Which sections document leak activities and verification testing?\",\"answer\":\"The form’s Leak Information section records leak found and leak repaired dates, initial leak verification test details, and final leak verification test dates, including the method and whether the test is after repair before charging or under normal load.\"},{\"question\":\"When should the trace gas and accidental release sections be used?\",\"answer\":\"Use the trace gas section only if trace gas is used, and use the accidental release section only if a refrigerant release occurs accidentally and is not due to mechanical failure, including the reason in the description area.\"}]","REFRIGERANT SERVICE ORDER FORM - HVAC Leak Service Checklist - Fill Out for Each Service | PDF",1790026928]