100605

• Document No.

• Dealer Name

• Job Name

• Conducted on

  Date

• Prepared by

• Location
  Address

• Names of installers/service technicians.

• Job Description and Weather Conditions

• Describe nature of the job being performed.

• Equipment model number(s)

• Equipment serial number(s)

Ductwork

• Is the overall duct system new, existing or existing with modifications?

  New

  Existing

  Existing with Modifications being performed

• Describe ductwork condition

• Is Manual D followed & were duct fittings and connections taken into consideration?

• Filter Configuration: (was any increase in p.d. accounted for)

• Indoor equipment tie in.

  Media

Equipment & Interconnecting Refrigerant Piping

• In the system an AHRI matched system?

  Select Yes No

  • Yes
  • No

• Equipment meets Manual S?

  Yes

  No

  N/A

• Refrigerant lines correct diameters?

  Yes

  No

• List refrigerant line diameters, lengths & rise:

• Does refrigerant lines qualify as long line?

  Yes

  No

• Have long line provisions been made?

  Yes

  No

  N/A

• Make any notes for this section here.

• Pictures of refrigerant lines connections:

  Media

General Installation

• If equipment includes gas/oil furnace; are gas/oil supply piping correct in diameter and installed properly?

  Yes

  No

  N/A

• Does Indoor equipment have proper clearance?

  Yes

  No

  N/A

• Does Outdoor equipment have proper clearance?

  Yes

  No

  N/A

• If proper clearances are not met, what needs to be corrected?

• Pics for any clearance issues:

  Media

• If equipment includes gas/oil furnace; are gas/oil supply piping correct in diameter and installed properly?

  Yes

  No

  N/A

• List any issues or notes for gas/oil piping:

• If equipment includes gas/oil furnace; is flue piping correct in size and installed properly?

  Yes

  No

  N/A

• List any issues or notes for gas/oil flue piping:

• Are electrical wire(s) correct size?

  Yes

  No

• Are electrical breaker(s) and disconnects the correct size?

  Yes

  No

• List any issues with electrical:

• List equipment safeties installed (i.e. EZ Trap):

• List any possible issues for serviceability:

• List any special controls or options:

Equipment Start Up

• Do installers have start procedure form(s) provided by their company?

  Yes

  No

• Were start up procedures followed completely?

  Yes

  No

  N/A

• List any deficiencies in dealers start up procedures/forms:

• List any steps NOT followed or skipped during start up:

• Were safeties tested during start up?

  Yes

  No

  N/A

• What documents were provided as evidence of proper start up and its results?

• Start Up Documents:

  Media

Wrap Up

• Final Notes:

• Job completion pics:

  Media

• Signature:

  Sign