Start Form - Daikin VHF Installation And Maintenance Manual

Water Source Heat Pump Equipment Check, Test and Start Form
This form must be completed and submitted within ten (10) days of start-up to comply with the terms of the Daikin warranty. Forms should
be returned to Daikin Warranty Department.
Job Name _________________________________________________________ Check, Test & Start Date ________________
City or Town __________________________________________ State _________________________ Zip ________________
Who is Performing CTS _____________________________________
General Contractor _________________________________________
Essential Items Check of System – Note: "No" answers below require notice to installer by memorandum (attached copy.)
A. Voltage Check __________ Volts
B. Yes No Condition
□ □
Loop Water Flushed Clean _________________________________________________________________
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Closed Type Cooling Tower _________________________________________________________________
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Water Flow Rate to Heat Pump Balanced ______________________________________________________
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Standby Pump Installed ___________________________________________________________________
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System Controls Functioning _______________________________________________________________
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Outdoor Portion of Water System Freeze Protected ______________________________________________
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Loop System Free of Air ___________________________________________________________________
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Filters Clean ____________________________________________________________________________
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Condensate Traps Installed _________________________________________________________________
Note: "No" answers below require notice to installer by memorandum (attached copy.)
□ □
Outdoor Air to Heat Pumps: ________________________________________________________________
□ □
Other Conditions Found: ___________________________________________________________________
Please include any suggestions or comments for Daikin Applied: ___________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Above System is in Proper Working Order
Note: This form must be filled out and sent to the warranty administrator
before any service money can be released.
Signature for Sales Representative
Signature for Customer
www.DaikinApplied.com
Installation Data
Essential Items Check
Loop Temp. ___________ °F Heating
Set For ___________ °F Cooling
Date
Equipment Type (Check all that apply)
□ □
Closed Loop
□ □
Geothermal
System Water P.H. Levels __________
Comments
Release:
SM ________________________
CTS ________________________
T ________________________
Service Manager Approval
58
Open Loop
Other (specify)______________
For Internal Use
Date
Form WS-CTS-00.01 (Rev. 4/14)
Vertical Stack WSHP • IM 986-11