PNC Retail HVAC Assessment - Survey Form NEW 1.2

• Site ID
  Address

• Conducted on

  Date

• Prepared by

• This inspection should be completed for each piece of HVAC equipment at each site.
  
  For Split Systems, please fill out 2 inspections (1 for the air handler & 1 for the condenser)
  
  For Unit Name, please refer to the below abbreviations.
  AHU - AIR HANDLING UNIT
  COND- AIR CONDENSING UNIT
  PKG - PACKAGE UNIT
  FCU - FANCOIL UNIT
  FURN - FURNACE
  BOIL - BOILER
  CHILL - CHILLER
  WU - WINDOW UNIT
  CRAC - COMPUTER ROOM AIR CONDITIONING
  PTAC - PACKAGED TERMINAL AIR CONDITIONER
  VAV - Variable Air Volume Units
  PIU - Power Induction Unit
  
  For VAV, please add the total number of pieces in the the Unit Type Notes section.

Survey Details

• HVAC Unit System Type

  Select Condenser (COND) Air Handling Unit (AHU) Packaged Unit (PKG) Furnace (FURN) Fan Coil Unit (FCU) Dehumidifier (DHUM) Boiler (BOIL) Chiller (CHILL) CRAC (CRAC) Cooling Tower (CT) Window Unit (WU) PTAC (PTAC) Other

  • Condenser (COND)
  • Air Handling Unit (AHU)
  • Packaged Unit (PKG)
  • Furnace (FURN)
  • Fan Coil Unit (FCU)
  • Dehumidifier (DHUM)
  • Boiler (BOIL)
  • Chiller (CHILL)
  • CRAC (CRAC)
  • Cooling Tower (CT)
  • Window Unit (WU)
  • PTAC (PTAC)
  • Other

• Please advise HVAC unit type

• Energy Source for Heating

  Select Heat Pump Electic Gas Oil Steam Water Other

  • Heat Pump
  • Electic
  • Gas
  • Oil
  • Steam
  • Water
  • Other

• Please advise heating source

• Equipment ID (Please use unit type + number. For example, the first package unit would be identified as PKG-01. Please confirm unit is labeled)

• HVAC Unit Serial Number

• HVAC Unit Model Number

• HVAC Unit Manufacturer

• HVAC Unit Size Capacity (in tons)

• Number of Circuits

  1

  2

  N/A

• Circuit 1 Factory Freon charge in lbs

• Circuit 2 Factory Freon charge in lbs (If there isn't a second circuit, please enter zero)

• Refrigerant Type

  R410A

  R22

  N/A

  Other

• Please advise refrigerant type

• Manufacturing year/ Year that Unit was Installed (estimate if not found)

• Take a Photo of Data Plate

  Media

• HVAC Unit location in the building

  Select Ground Attic Basement Roof Mechanical Room ATM Room Closet Other

  • Ground
  • Attic
  • Basement
  • Roof
  • Mechanical Room
  • ATM Room
  • Closet
  • Other

• Please advise location in the building

• Area Served by HVAC Unit (Select all that apply)

  Select 1st Floor 2nd Floor 3rd Floor Lobby Office Common Area Teller Area Breakroom ATM Room Drive Thru Entire Branch Server Room Bathroom Vault Other

  • 1st Floor
  • 2nd Floor
  • 3rd Floor
  • Lobby
  • Office
  • Common Area
  • Teller Area
  • Breakroom
  • ATM Room
  • Drive Thru
  • Entire Branch
  • Server Room
  • Bathroom
  • Vault
  • Other

• Please advise area served by HVAC Unit

• Can Occupants Adjust or Control Start/Stop on this Unit?

  Yes

  No

• Is the T-Stat Programmable?

  Yes

  No

• What are the bank's occupied hours of operation? Select all that apply

  Select Monday-Friday 8AM-5PM Monday-Friday 9AM-5PM Monday-Friday 9AM-6PM Saturday 9AM-1PM Sunday 9AM-1PM Open 24 Hours Other

  • Monday-Friday 8AM-5PM
  • Monday-Friday 9AM-5PM
  • Monday-Friday 9AM-6PM
  • Saturday 9AM-1PM
  • Sunday 9AM-1PM
  • Open 24 Hours
  • Other

• Temperature Set Points for Heat

• Temperature Set Points for Cool

• Is this a split system?

  Yes

  No

• Please identify the air handler or condenser that this piece of equipment is linked to

• Is this HVAC unit replacing an old unit?

  Yes

  No

• Please identify the unit that was replaced

Asset Condition Measurement

• Asset Age

  Select Excellent: 0-3 Years Old (Asset new or nearly new) Good: 3-6 Years Old (Asset nearing or at its midlife point) Adequate: 6-9 Years Old (Asset has passed its midlife point) Marginal: 9-12 Years Old (Asset nearing or at end of its useful life) Poor: Over 12 Years Old (Asset passed its useful life) Asset Non-operable or Unsafe

  • Excellent: 0-3 Years Old (Asset new or nearly new)
  • Good: 3-6 Years Old (Asset nearing or at its midlife point)
  • Adequate: 6-9 Years Old (Asset has passed its midlife point)
  • Marginal: 9-12 Years Old (Asset nearing or at end of its useful life)
  • Poor: Over 12 Years Old (Asset passed its useful life)
  • Asset Non-operable or Unsafe

• Asset Condition (Quality, Level of Maintenance Required)

  Select Excellent: Asset new or like new; no visible defects Good: Asset showing minimal signs of wear; some slight defects or deterioration Adequate: Some moderately defective or deteriorated components; expected maintenance needs Marginal: Increasing numbers of defects; deteriorating components; growing maintenance needs Poor: Asset in need of replacement or restoration; may have critically damaged components Asset Non-operable or Unsafe

  • Excellent: Asset new or like new; no visible defects
  • Good: Asset showing minimal signs of wear; some slight defects or deterioration
  • Adequate: Some moderately defective or deteriorated components; expected maintenance needs
  • Marginal: Increasing numbers of defects; deteriorating components; growing maintenance needs
  • Poor: Asset in need of replacement or restoration; may have critically damaged components
  • Asset Non-operable or Unsafe

• Asset Performance (Reliability, Safety, Meets Industry Standards)

  Select Excellent: Asset meets or exceeds all performance and reliability metrics, industry standards Good: Asset generally meets performance and reliability metrics, industry standards Adequate: Occasional performance and reliability issues; may be substandard in some areas Marginal: Performance and reliability problems becoming more serious; sub-standard elements Poor: Frequent performance and reliability problems; does not meet industry standards Asset Non-operable or Unsafe

  • Excellent: Asset meets or exceeds all performance and reliability metrics, industry standards
  • Good: Asset generally meets performance and reliability metrics, industry standards
  • Adequate: Occasional performance and reliability issues; may be substandard in some areas
  • Marginal: Performance and reliability problems becoming more serious; sub-standard elements
  • Poor: Frequent performance and reliability problems; does not meet industry standards
  • Asset Non-operable or Unsafe

• Level of Repairs/Maintenance

  Select Excellent: No corrective maintenance requests/ only preventative maintenance being completed Good: Received a few corrective maintenance requests Adequate: Received more frequent corrective maintenance requests and some minor component failures Marginal: Corrective maintenance activities frequently, including major components needing replacement or rehab Poor: Major component failures Asset Non-operable or Unsafe

  • Excellent: No corrective maintenance requests/ only preventative maintenance being completed
  • Good: Received a few corrective maintenance requests
  • Adequate: Received more frequent corrective maintenance requests and some minor component failures
  • Marginal: Corrective maintenance activities frequently, including major components needing replacement or rehab
  • Poor: Major component failures
  • Asset Non-operable or Unsafe

• Additional Comments for or against replacement

Sign Off

• Name and Signature

  Sign