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To whom it may concern:
Please review the items below upon receiving and installing our product. Select N/A on any item that does not apply to the product.
Job Name: _____________________________________________________________________
Installation address: ____________________________________________________________________________________________________
City: ___________________________________________________________________________ State: _______________________________
Purchasing contractor:__________________________________________________________________________________________________
City: ___________________________________________________________________________ State: _______________________________
Name of person doing start-up (print): ___________________________________________________________________________________
Company name:______________________________________________________________________________________
Address:____________________________________________________________________________________________
City/State/Zip: _______________________________________________________________________________________
Unit model number: ____________________________________________________
1. Is there any shipping damage visible? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes
Location on unit ____________________________________________________________________________________
2. How would you rate the overall appearance of the product; i.e., paint, fi n damage, etc.?
3. Did all sections of the unit fi t together properly? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes
4. Did the cabinet have any air leakage? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes
Location on unit ___________________________________________________________________________________
5. Were there any refrigerant leaks? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes
From where did it occur? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. Does the refrigerant piping have excessive vibration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes
Location on unit ___________________________________________________________________________________
7. Did all of the electrical controls function at start-up? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes
Comments _______________________________________________________________________________________
8. Did the labeling and schematics provide adequate information? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes
9. How would you rate the serviceability of the product?
10. How would you rate the overall quality of the product?
11. How does the quality of Daikin Applied products rank in relation to competitive products?
Comments _______________________________________________________________________________________
Please list any additional comments which could aff ect the operation of this unit; i.e., shipping damage, failed components, adverse installation applications, etc. If additional comment
space is needed, write the comment(s) on a separate sheet, attach the sheet to this completed Quality Assurance Survey Report, and return it to the Warranty Department with the
completed preceding "Equipment Warranty Registration Form".
13F-4160 (02/16)
Quality Assurance Survey Report
Daikin Applied S.O. No._______________
Unit serial number: __________________________
Shipping
Workmanship
©2016 Daikin Applied • (800) 432-1342 • www.DaikinApplied.com
No
Excellent
Good
Fair
No
No
No
Design
No
No
No
Excellent
Good
Fair
Excellent
Good
Fair
Excellent
Good
Fair
Q
a
s
ualITy
ssuranCe
urvey
N/A
Poor
N/A
N/A
N/A
N/A
N/A
N/A
Poor
Poor
Poor
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