Record sheet for refrigerant gases

General Information
Plant Name Reference No.
Location of Plant
Plant Operator (Name, Address, Telephone)
Operator Contact
Cooling loads Served
Refrigerant Type Refrigerant Quantity (Kg)
Plant Manufacturer Date of Installation
Refrigerant Additions
Date Technician / Company Amount Added (Kg) Reason for Addition
Refrigerant Removals
Date Technician / Company Amount Removed (Kg) Reason for Removal
Leak Tests
Date Technician / Company Pass Fail Reason if fail (Inc. location, follow up action & cause of any leaks)
Follow-up Action
Date Technician / Company Related to test (date) Action Taken
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