Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

Faclities Details

  • Check if you want to enter Facility Details

  • Year Constructed

  • Square Footage

  • Building style

  • General HVAC/Controls Description

HVAC Systems

  • Check if you want to Complete HAVC System Assessment

RTU Assessment

  • Check if you are completing a RTU Assessment

  • Add Record

RTU Unit Details

  • Enter RTU Tag #

  • Manufacture

  • Model #

  • Serial #

  • Voltage

  • Max Overcurrent Protection Amps

  • Year Installed

  • Can we interface to this unit with BacNet, Lon, Bridge

  • Select Which

RTU Assessment Findings

  • Check if your want to enter assessment findings

  • General Unit Condtion

  • Type of Heat – Hot Water, Gas or NA

  • Control Signal

  • Type of Compressors

  • VFD or Constant Volume

  • Outside Air Flow Measuring Station

  • Energy Recovery Unit Installed

  • Identify the unit information

Condition Assessment of Componets

  • Cabinet, Evap Coil, Condenser Coil

  • VFD’s

  • Damper Actuators

  • Pulleys, sheaves and bearings

  • Desiccant Belt, Wheel

  • Dampers

  • Duct Static Pressure Sensor

  • Return Fan Motor

  • Exhaust Fan

  • Recirc pump if hot water coil

  • Freeze Stat

  • DAT, MAT, RAT, RH sensors

  • Filters

  • Ductwork – any noticeable air leaks

  • Diversity of system Load vs. Deliverable air

  • Check Curb and record all measurements

  • Front to Nearest Obstruction

  • Back to Nearest Obstruction

  • Side 1 to Nearest Obstruction

  • Side 2 to Nearest Obstruction

  • Is system Clean and free of debris

Boiler Systems

  • Check if you are completing a Boiler Assessment

  • Add Record

Boiler Unit Details

  • Unit Tag #

  • Manufacture

  • Model #

  • Serial #

  • BTU Input/Output

  • Year Installed

Boiler Assessment Findings

  • Check if your completing the assessment now

  • Condition of piping – will it require rework for new boilers

  • Are the current boilers sized correctly

  • How has the maintenance cost been for the existing boilers

  • Are there other parts of the boiler plant will need to be replaced

  • Back flow preventer

  • Fill valve

  • Expansion Tank

  • Air Separator

  • Isolation valves

  • Vent Piping

  • Safeties LWCO, High Limit, Flow Switch, Boiler and System safety relief valves Circuit Setters

  • Concentric Terminations

  • Gas Piping

  • Should the piping being changed to Primary / Secondary

  • Are controls currently installed

  • Select Which

  • Combustion air dampers will they be needed, do they have a running interlock to the boiler system (end Switch)

  • Boiler Inspection Scheduled

  • What is the date and time

System Pumps

  • Check Box if you are completing a pump system assessment

  • Click add at top of category to add units

Pump Details

  • Unit Tag #

  • Type of pump

  • Manufacture

  • Model #

  • Pump impeller

  • Voltage / Phase

  • Year Installed

Pump System Assessment Findings

  • Check Box if you are completing this section now

  • Have the Pumps have been rebuilt

  • Any Leaks

  • Should they be replaced with high efficiency sealed circulators

  • Will replacement require piping modifications

  • What type of controls are currently in

  • How are they being controller, list control points

  • can they be converted to DDC

  • Have Strainer been Cleaned

VAV Controls

  • Check box if your are completing a VAV Controls assessment

VAV System Details

  • Total Quantity

  • Fan Powered Qty

  • VAV Manufacture

  • Control Valve Style 2way, 3way, 2position, modulating (tri-state, 2-10vdc, 4-20ma)

  • Can we reuse control valves

  • Are circuit setters in good condition

  • Year Installed

  • Are there known issues – ask Center Manager

  • Leaks

  • Hot / Cold Spots

  • Drafts

  • Can we reuse 24vac power wire

  • Type of Reheat – Hot Water or Electric

  • How accessible or serviceable

  • Existing DAT – can it be used on our system

  • Condition of hard ductwork and flex

  • What type of Damper Actuator is installed

  • Can we reuse the damper actuator

  • Can we interface to this unit with BacNet, Lon, Bridge

  • Select Which

  • T-stat locations compared to what VAV the control

  • Does VAV supply more than one room with T-stat control in another room

  • Can this VAV be repurposed to supply an office

  • Are there any VAV’s above the ceiling not feeding anything

  • Are the flow rings and coil clean

Controls Systems

  • Check box if your are completing a Controls System assessment

Controls System Details

  • Manufacture

  • Year Installed

  • Is there a dedicated PC

  • Is this system obsolete

  • Does this system have remote access

  • Suggestions for new system

  • Existing Graphics

  • Building Static Pressure Control

  • Are there existing controls and can we interface to this unit with BacNet, Lon, Bridge

Exhaust Fans

  • Check box if your are completing a Exhaust Fan assessment

  • Add Record

Exhaust Fan Details

  • Tag #

  • Manufacture

  • Model

  • Serial #

  • Voltage / Phase

Assessment Findings

  • Is status monitored by control system

  • Is enable signal from control system

  • Is this unit in good shape or should it be replaced

  • Should this unit be added to the control system

  • Is there an existing isolation damper

  • Is there and existing speed controller to be used for balancing

  • Is the unit vented outside, if not can it be vented outside

  • Any roof work required

  • Are the fans clean

Water Heater

  • Check box if your are completing a water heater assessment

  • Add Record

Water Heater Details

  • Manufacture

  • Model

  • Serial #

Assessment Findings

  • Is this High efficiency design

  • Is unit past its normal life expectancy

  • Is Properly sized for the demands of the facility

  • If Re-circulation pump is original should it be replaced

  • Would a tank less water heater with internal circulator work for this facility

Miscellaneous Equipment

  • Check box if your are completing a Miscellaneous Equipment assessment

  • Add record

Miscellaneous Equipment Details

  • Manufacture

  • Model

  • Serial #

  • Control

  • Valve

  • Relay

  • Current Sensor

  • Does it work

  • Is it clean

Loading Dock

  • Type Door

  • Can we mount a door contactor

  • Is there a Unit Heater in Dock

  • Type of controls valve

  • Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.