HVAC Full System Assessment

• Customer Name

• Location
  Address

• Date

  Date

• Purpose of report

  Diagnosis

  Post- Repair Test Out

  Maintenance

  Real Estate Assessment

• Reasons for concern

  Select Sudden or intermittent system breakdown Hot/ Cold spots High Humidity Low Humidity Poor air quality/ allergies Noise Strange smell High energy usage/ bills Poor airflow Water leak Other- Comment below N/A

  • Sudden or intermittent system breakdown
  • Hot/ Cold spots
  • High Humidity
  • Low Humidity
  • Poor air quality/ allergies
  • Noise
  • Strange smell
  • High energy usage/ bills
  • Poor airflow
  • Water leak
  • Other- Comment below
  • N/A

System

• System Tag or Area Served

• System Type

  Select Split Gas/ AC Split Heat Pump Packaged Gas/ AC Packaged Heat Pump Split Hybrid Packaged Hybrid Ductless N/A

  • Split Gas/ AC
  • Split Heat Pump
  • Packaged Gas/ AC
  • Packaged Heat Pump
  • Split Hybrid
  • Packaged Hybrid
  • Ductless
  • N/A

• Refrigerant

  R410A

  R22

  Other

  N/A

• Energy saving thermostat?

  Yes

  No

  N/A

• Carbon Monoxide detector present?

  Safe

  At Risk

  N/A

• Type of air filter(s). List quantity and sizes in comments.

  MERV 10+

  MERV 6-9

  MERV 5 or less

• Condition of air filter(s)

  Good

  Fair

  Poor

  N/A

• Furnace Model/ Serial

• Furnace age

  Less than 5

  5-10

  10-15

  Over 15

• Coil Model/ Serial

• Coil age

  Less than 5

  5-10

  10-15

  Over 15

• Indoor equipment condition, serviceablility and workmanship

  Pass

  Fail

  N/A

• Blower motor and assembly condition

  Pass

  Fail

  N/A

• Condition of indoor coil

  Pass

  Fail

  N/A

• Refrigerant piping condition and workmanship

  Pass

  Fail

  N/A

• Signs of refrigerant leak?

  Pass

  Fail

  N/A

• Condensate piping, trap and cleanout condition, accessibility and workmanship

  Pass

  Fail

  N/A

• Condensate overflow safety devices properly installed?

  Safe

  At Risk

  N/A

• Indoor service disconnect and wiring condition

  Safe

  At Risk

  N/A

• Indoor equipment wiring and electrical components condition

  Pass

  Fail

  N/A

• Indoor capacitor condition, actual vs rated MFD

  Pass

  Fail

  N/A

• Gas piping condition and workmanship

  Safe

  At Risk

  N/A

• Vent piping condition, clearance to combustibles and workmanship

  Safe

  At Risk

  N/A

• Burner, and heat exchanger condition

  Pass

  Fail

  N/A

• Flame rod condition

  Pass

  Fail

  N/A

• Inducer assembly condition

  Pass

  Fail

  N/A

• Test operation of safeties

  Safe

  At Risk

  N/A

• Ductwork overall condition

  Pass

  Fail

  N/A

• Ductwork sizing and workmanship

  Pass

  Fail

  N/A

• Ductwork insulation and sealing

  Pass

  Fail

  N/A

• Outdoor unit Model/ Serial

• Outdoor unit age

  Less than 5

  5-10

  10-15

  Over 15

• Outdoor unit serviceability and workmanship

  Pass

  Fail

  N/A

• Outdoor coil condition

  Pass

  Fail

  N/A

• Compressor condition

  Pass

  Fail

  N/A

• Outdoor fan condition

  Pass

  Fail

  N/A

• Reversing valve condition and operation.

  Pass

  Fail

  N/A

• Outdoor service disconnect and wiring condition

  Safe

  At Risk

  N/A

• Outdoor equipment wiring and electrical components condition

  Safe

  At Risk

  N/A

• Outdoor capacitor(s) condition, rated vs actual MFD

  Pass

  Fail

  N/A

• Outdoor contactor condition

  Pass

  Fail

  N/A

• AC Surge protector installed?

  Safe

  At Risk

  N/A

• System Tested In Cooling or Heating?

  Cooling

  Heating

• Total Static Pressure. Show MeasureQuick ⚡️Screenshots.

  Under 0.6”

  0.6”-0.7”

  Over 0.7”

• CFM's Per Ton. Show MeasureQuick Screenshots.

  Less than 350

  350-450

  Over 450

• Temperature Split and Enthalpy. Show MeasureQuick 🏠 Screenshots.

  Good

  Fair

  Poor

  N/A

• Indoor humidity/ dew point. Show MeasureQuick 🏠 Screenshots.

  Good

  Fair

  Poor

  N/A

• Superheat and Subcooling. Show MeasureQuick ☀️ Screenshots.

  Good

  Fair

  Poor

  N/A

• Compression ratio and Approach. Show Measurequick ☀️ Screenshots.

  Under 2.0

  2.0- 3.0

  3.0- 4.0

  Over 4.0

  N/A

• Total Capacity. Show MeasureQuick⚡️ Screenshots.

  Good

  Fair

  Poor

  N/A

• Operating SEER. Show MeasureQuick ⚡️Screenshots.

  17+

  14-16

  12-13

  Under 12

  N/A

• Operating COP. Show MeasureQuick ⚡️Screenshots.

  Under 1

  1-2

  2-3

  Over4

  N/A

• Heat Pump- Verify operation of defrost mode.

  Pass

  Fail

  N/A

• Heat Pump- Verify operation of auxiliary/ emergency heat operation.

  Pass

  Fail

  N/A

• Gas- Draft Pressure under worst case de-pressurization

  Safe

  At Risk

  N/A

• Gas- Burner flame condition, color and stability

  Pass

  Fail

  N/A

• Gas- Input Pressure

  Pass

  Fail

  N/A

• Gas- Manifold Pressure

  Pass

  Fail

  N/A

• Gas- Vent pipe CO level under worst case de-pressurization.

  Safe

  At Risk

  N/A

• Gas- Combustion Efficiency %. Show Combustion Analysis.

  Pass

  Fail

  N/A

• Indoor Air Quality Snapshot. Capture ATMO Tube Pro AND CO Detector levels.

  Safe

  At Risk

  N/A

Maintenance Checklist- Performed at maintenance visits only.

• Washed coils.

• Wax outdoor unit

• Replaced filters.

• Sanitized inside of air handler cabinet and motor.

• Treated drain pan, flushed condensate piping.

• Tightened all electrical connections starting from service disconnect.

• Gas- Cleaned flame rod and burner assembly.

Summary and Recommendations

• Summary of services provided and findings.

• Recommendation 1 (60 day No- Break Down Guarantee)

• Recommendation 2

• Recommendation 3

• Recommendation 4

• I acknowledge that this report has been provided and reviewed with me as the building owner or its representative. I also understand that in order to receive the 60 day no break down guarantee, Recommendation 1 must be approved, completed and paid in full.

  Sign