Refrigeration System Leak Documentation Form
Facility / Site Name
Location
Date
Technician Name
Refrigeration System ID / Description
Refrigerant Type
Estimated Amount Leaked (kg/lb)
Leak Detected By
Description of Leak (location, type, etc.)
Suspected Cause
Corrective Action Taken
Date Leak Repaired
Verified Leak-Free (Y/N)
Y
N
Additional Notes