Information
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Residential Split System Site Visit Report
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Dealer Name & Acct #
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Individuals present during visit
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Owner Name
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Address
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Conducted on
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Customer Assurance Manager
Reason for site visit
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Seibel or Site Visit Request Form (required)
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Is this in response to a Seibel report?
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Seibel #
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Complaint or reason for site visit
- Capacity
- Indoor unit
- Outdoor unit
- Other
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Explain capacity issues
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Indoor unit concerns related to?
- Airflow
- Refrigerant leak
- Water leak
- Mechanical
- Other
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Explain
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Outdoor unit concerns related to?
- Compressor
- Coil
- Control board
- Reversing valve
- Other
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Explain
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Explain
Equipment
Equipment Component Information:
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System
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System identification
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Equipment Component Type
Equipment Component Model and Serial
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Describe "Other".
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Model number
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Serial number
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Start Date
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Warranty
- Expired
- 5 year
- 10 Year
- 10 year parts Contract
- 5 Year P & L
- 10 Year P & L
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Unit Photo
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Metering Device Type
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Piston Size Required?
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Piston Size Installed?
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Is the sensing bulb mounted properly and insulated?
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Filter type
- 1" Fiberglass/Poly
- 1" Pleated
- 2" Pleated
- 4" Media
- Air Purifier
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Model:
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Serial:
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Notes:
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Quantity and size of filters.
Application
Application Information
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System
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System identifier
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Control Type
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Brand / Model
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T-Stat photos.
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Brand / Model
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T-Stat Photos.
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UI Model
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UI Serial
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List UI Configurations
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UI Photos
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Describe Control
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Photo of "Other Control".
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Indoor unit location
- Conditioned Space
- Unconditioned Attic
- Conditioned Attic
- Unconditioned Garage
- Unconditioned Crawl Space
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Orientation
- Upflow
- Downflow
- Horizontal Right
- Horizontal Left
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Converted properly?
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Outdoor unit location
- Above Indoor Unit
- Below Indoor Unit
- Same elevation
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Line set properly sized
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Liquid line size?
- 1/4"
- 5/16"
- 3/8"
- 1/2"
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Vapor line size?
- 5/8"
- 3/4"
- 7/8"
- 1 1/8"
- 1 3/8"
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Vertical separation in feet:
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Long line set application required?
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Length? Accessories used and note all required.
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Approximate refrigerant line length.
Detailed Operating Info
Detailed operational information
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System
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System identifier
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Equipment mode of operation?
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Equipment
- A/C
- Furnace
- Heat Pump
- Fan Coil
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Furnace
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Is polarity correct?
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Grounded properly?
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Fault code displayed?
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List fault codes
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Furnace control board dip switch settings.
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Fuel Type
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Is LP Conversion Kit Properly Installed?
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Is low gas pressure control installed and correctly wired?
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Furnace control board dip switch settings and/or speed taps used.
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Is airflow correct?
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Total External Static Pressure
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Return static pressure
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Supply static pressure
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CFM
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Method used to determine airflow
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Temperature rise on high stage.
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Flue type and size
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Horizontal length?
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Vertical length?
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Photo of roof showing vent termination.
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Flue temp
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Combustion air location
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Cased coil condition?
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Explain
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Cased coil 🔼P
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Fan Coil
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Is a heat kit installed?
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Heat Kit Model#
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Heat Kit Serial#
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Heat Kit KW?
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Amperage for each element?
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Motor Amp draw
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Total Amp Draw for Fan Coil and All Heating Elements (without heat pump)
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Fault code displayed
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List fault codes
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Is airflow correct?
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External Static Pressure
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Return external static?
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Supply external static pressure?
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CFM
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Method used to determine airflow
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Does motor run?
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External Static Pressure
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Return external static pressure?
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Supply external static pressure?
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CFM
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Method used to determine airflow
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Motor winding resistance - show resistance of all windings
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Entering Air Dry Bulb
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Leaving Air Dry Bulb
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Evaporator coil condition
- Clean
- Dirty
- Other
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Explain
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Is drain line properly trapped?
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Photo of drain line including trap.
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Is the blower wheel clean?
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Does unit run?
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Fault code displayed?
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List fault codes
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Compressor Run Capacitor MFD Rating?
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Compressor Run Capacitor MFD Actual?
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Compressor Amps: Start /Run /Common:
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Liquid Line Pressure?
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Liquid Line Saturated Temperature.
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Sub-Cooling?
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Suction Pressure
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Actual Suction Temperature.
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Superheat?
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Discharge line temperature
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Reversing valve operational test performed?
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Suction line temperature entering valve.
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Suction line temperature leaving valve.
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🚩 VALVE IS FAULTY! REPLACE VALVE! 🚩
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Hot Gas line temperature entering valve.
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Hot Gas line temperature leaving valve.
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🚩 VALVE IS FAULTY! REPLACE VALVE! 🚩
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Outdoor Air Temperature
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Discharge air temperature. Calculate average temperature from at least 4 locations.
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Equipment
- A/C
- Furnace
- Heat Pump
- Fan Coil
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Furnace
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Is polarity correct?
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Grounded properly?
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Fault code displayed?
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List fault codes
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Is airflow correct?
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External Static Pressure
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Return external static pressure?
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Supply external static pressure?
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CFM
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Method used to determine airflow
- Magnahellic
- Traverse
- Flow hood
- User Interface
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Cased Coil Condition?
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Explain
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Cased coil 🔼P
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Fault code displayed?
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List fault codes
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T-Stat / UI Photos.
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Blower speed taps used:
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Is airflow correct?
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External Static Pressure
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Return external static pressure?
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Supply external static pressure?
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CFM
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Method used to determine airflow
- Magnahellic
- Traverse
- Flow hood
- User Interface
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Condition of evaporator coil?
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Explain
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Is blower wheel clean?
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Explain
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Entering air dry bulb
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Entering air wet bulb
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Entering air %RH
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Leaving air dry bulb
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Leaving air wet bulb
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Leaving air %RH
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Liquid line temperature @ indoor unit
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Vapor line temperature @ indoor unit
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Air Conditioning Readings
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Fault code displayed?
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List fault codes
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T-Stat / UI Photos.
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Compressor Amps Start/ Run / Common:
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Compressor Run Capacitor Mfd Rating:
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Compressor Run Capacitor Mfd Actual
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Start Kit Installed?
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OEM or Generic?
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Is filter drier installed?
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Location of drier?
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🔼T on Drier?
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Liquid line pressure
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Saturated Liquid Line Temperature.
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Liquid line actual temperature
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Sub-cooling required.
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Sub-cooling Actual
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Vapor line pressure
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Vapor line saturated temperature
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Vapor line actual temperature.
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Superheat Required.
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Superheat Actual.
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Traps in refrigerant lines?
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Describe traps and length.
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Outdoor air temperature
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Discharge air temperature. Calculate average temperature from at least 4 locations.
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Condition of outdoor coil
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If 2 row coil, was the coil separated to inspect and/or cleaned?
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Explain type and extent of damage
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Fault code displayed?
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List fault codes
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T-Stat / UI Photos.
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Compressor Amps Start/ Run / Common:
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Compressor Run Capacitor Mfd Rating:
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Compressor Run Capacitor Mfd Actual
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Start Kit Installed?
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OEM or Generic?
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Is filter drier installed?
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Location of drier?
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🔼T on Drier?
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Liquid line pressure
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Saturated Liquid Line Temperature.
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Liquid line actual temperature
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Sub-cooling required.
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Sub-cooling Actual
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Vapor line pressure
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Vapor line saturated temperature
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Vapor line actual temperature.
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Superheat Required.
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Superheat Actual.
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Traps in refrigerant lines?
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Describe traps and length.
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Reversing valve operational test performed?
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Suction line temperature entering valve.
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Suction line temperature leaving valve.
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🚩 VALVE IS FAULTY! REPLACE VALVE! 🚩
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Hot Gas line temperature entering valve.
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Hot Gas line temperature leaving valve.
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🚩 VALVE IS FAULTY! REPLACE VALVE! 🚩
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Outdoor air temperature
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Discharge air temperature. Average temperature from at least 4 locations.
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Condition of outdoor coil
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If 2 row coil, was the coil separated to inspect and/or cleaned?
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Explain type and extent of damage
Observation
Field Observations
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Observations
Observation
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The following conditions were observed on this visit:
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Add media
Recommendation
Recommendations
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Recommendations
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We recommend the following be performed:
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Photos to support recommendations
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Is a follow up visit required?
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Proposed date of follow up.
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Proposed time of follow up.