Water Source Heat Pump Equipment Check, Test; And Start Form - Daikin WAA 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 _________________________________________________________________
□ □
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
IM 447-11
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
32
Open Loop
Other (specify)______________
For Internal Use
Date
Form WS-CTS-00.01 (Rev. 4/14)
www.DaikinApplied.com