BTS Dampers/ Damper Control Units Maintenance Certificate

• Site Name:

• Conducted on

  Date

Customer overview

• Job Number:

• Site Name:

• PPM number:

System Overview

• Variations from the recommendations of Clause 45 of BS5839-1:2013 for periodic or annual inspection and test (as applicable).

• Maintenance Visits quarter number:

  Qtr 1

  Qtr 2

  Qtr 3

  Qtr 4

Functional Equipment Testing:

• Has the control equipment/ damper/s been tested

  Yes

• Are all controls and visual indicators at panel OK?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Are all ancillary functions of the panel OK?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Please state below Details of Work completed/Comments & Additional work undertaken

• Any other issues conditions also with the installation additions or rectifications required

Engineers' Time Sheet a Summary:

• Enter Date of testing

  Date

Customer Acceptance:

• Engineers Name on behalf of BTS:

• BTS Engineer's Signature:

  Sign

• Customer Acknowledgement (INPUT NAME): I confirm the satisfactory completion of the above maintenance visit.

  Sign

• Customer Job Title:

• Customer Signature:

  Sign

Office use ONLY:

• Closed:

• Invoiced (where applicable):

• Actioned by:

• Date Closed:

BTS Company Details:

• Building Technology Services 119a Derby Street Burton-on-Trent DE14 2LE Tel:01283 566 977 Email: service@buildingtechnologyservices.co.uk

• Document Reference Number QD53c, Rev 3, June 2014