Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
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Project
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Date
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Pump Tag
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Building
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Location
Untitled Page
Pump 1 Information
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Make
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Model Number
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Serial Number
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GPM
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Head
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Volts/Phase
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Function
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Service Area
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Motor HP
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Motor Eff
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RPM
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Comments
Pump 2 Information
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Make
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Model Number
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Serial Number
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GPM
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Head
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Volts/Phase
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Fuction
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Service Area
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Motor HP
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Motor Eff
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RPM
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Comments
Pump 3 Information
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Make
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Model Number
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Serial Number
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GPM
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Head
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Volts/Phase
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Function
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Service Area
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Motor HP
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Motor Eff
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RPM
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Comments
Associated Checklists
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Comments
Installation Checks
General
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Installation is per manufacturer’s instructions
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Comments
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Manufacturer’s recommended spare parts are provided
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Comments
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Equipment label permanently affixed
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Comments
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Pump lubricated
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undefined
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Pump drive properly aligned
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Comments
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Drive guard or shield is properly installed
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Comments
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Pump foundation is level
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Comments
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Pumps in place and properly anchored
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Comments
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Pipes are supported independently of the pump
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Comments
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Vibration isolation devices installed and functional
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Comments
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Seismic anchoring installed and functional where applicable
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Comments
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Isolation valves and piping specialties installed
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Comments
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Shaft seal is leak free
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Comments
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Pump detail checked against the drawings and all devices gages and appurtenances are in place
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Comments
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Insulation installed per requirements; insulated to avoid condensation yet allow for service
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Comments
Electrical and Controls
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Power disconnects located within site of the unit it controls and labeled
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Comments
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All electric connections tight
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Comments
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Grounding installed for components and unit
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Comments
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Safeties installed and operational
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Comments
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Starter overload breakers installed and correct size
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Comments
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All control devices and wiring complete
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Comments
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Control system interlocks connected and functional
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Comments
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Rotates in the correct direction (for VFD, check inverter and Bypass modes)
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Comments
VFD
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Drive location not subject to excessive moisture or dirt
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Comments
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Drive location not subject to excessive temperatures
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Comments
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Appropriate Volts vs. Hz curve is being used
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Comments
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Drive size matches motor size
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Comments
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Drive mounted on housekeeping pad (if applicable)
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Comments
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Cooling air flow path clean and unobstructed
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Comments
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Permanent label affixed
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Comments
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VFD interlocked to control system
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Comments
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Unit is programmed with full written programming record on site
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Comments
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Minimum and maximum speed set
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Comments
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Where applicable, ensure safeties are active in all modes
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Comments
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Coordinated with BAS for all interface ranges and signal isolation
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Comments
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Restart on Power Failure parameter set to auto
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Comments
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VFD powered (wired to controlled equipment)
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Comments
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Grounding installed for components and unit
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Comments
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Drive min and max speed set to ___ Hz min and 60 Hz max
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Comments
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Security settings set per owner direction and password documented for owner
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Comments
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Upper frequency limit set at 100%, unless explained otherwise
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Comments
Sensors and Gages
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Temperature, pressure and flow gages and sensors installed
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Comments
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Piping gages, BAS and associated panel temperature and pressure readouts match.
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Comments
Untitled Page
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LEED CxA
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Date
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Owner's Representative
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Date
