Equipment Leak Detection Report
General Information
Date:
Inspector Name:
Location:
Equipment ID/Name:
Department:
Leak Details
Leak Source:
Type of Leak:
Gas
Liquid
Vapor
Other
Estimated Leak Rate:
Detection Method:
Leak Location Description:
Actions Taken
Immediate Action Taken:
Further Action/Recommendations:
Parts Replaced/Serviced (if any):
Sign-Off
Name
Role
Date
Signature