Run HVAC Filter Change Verification - Healthcare — Free

Inspection Details and Room Identification

Room type confirmed critical (required)

Identify the space being inspected.

Note (optional)

Inspection date and time recorded

Inspector name and department recorded

Maintenance work order or service ticket number recorded

Filter Change Verification

Filter change completed per approved SOP critical (required)

Verify the filter replacement was performed according to facility procedure and infection control requirements.

Yes No N/A

Correct filter type installed critical (required)

Confirm the installed filter matches the required specification for the room and air handling unit.

Note (optional)

Filter media and frame free of damage, bypass, or improper seating critical (required)

Inspect for tears, gaps, crushed media, missing gaskets, or evidence of air bypass around the filter.

Yes No N/A

Filter change date or replacement label applied

Verify the filter or housing is labeled with the replacement date and installer identification where required by site procedure.

Yes No N/A

Removed filter disposed of per infection control procedure

Confirm used filters were handled, bagged, and disposed of according to facility infection control and waste procedures.

Yes No N/A

Pressure Differential and Airflow Checks

Room pressure differential measured critical (required)

Record the measured pressure differential between the room and adjacent corridor or reference space.

Note (optional)

Pressure relationship matches room function critical (required)

Verify the room is maintaining the required directional airflow for its use.

Note (optional)

Pressure monitor or visual indicator functioning critical (required)

Confirm the room pressure monitor, gauge, or alarm is operating and readable.

Yes No N/A

Door closed condition maintained during verification critical (required)

Verify the pressure reading was taken with the door in the normal closed condition unless the procedure specifies otherwise.

Yes No N/A

Airflow at supply and return points appears unobstructed

Check that supply diffusers, return grilles, and transfer paths are unobstructed and not blocked by equipment or storage.

Yes No N/A

System Condition and Infection Control Safeguards

Access panels and filter housing secured after service critical (required)

Verify all access doors, latches, and fasteners are secured and the system is left in normal operating condition.

Yes No N/A

No visible dust release, leakage, or contamination observed critical (required)

Inspect the surrounding area for signs of dust release, loose debris, or contamination from the filter change activity.

Yes No N/A

Any alarms, deficiencies, or non-conformances documented

Record whether any HVAC alarms, abnormal readings, or non-conforming conditions were identified during the inspection.

Yes No N/A

Corrective Actions and Sign-Off

Corrective actions documented for all failed items critical (required)

Document the deficiency, immediate containment, responsible party, and target completion date for each failed item.

Yes No N/A

Inspector signature completed critical (required)

Get your results

Enter your email — we'll send you a PDF of your filled-out template. We won't sign you up to anything; you can opt in to the trial from the email if you want.

Email (required)

Your name (optional)

Run: HVAC Filter Change Verification - Healthcare

Inspection Details and Room Identification

Filter Change Verification

Pressure Differential and Airflow Checks

System Condition and Infection Control Safeguards

Corrective Actions and Sign-Off

Get your results