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Dear Installer / Customer
A copy of this installation report filled out in full and signed can be attached to an STC Assignment Form (where
applicable) as a method to demonstrate proof of installation. It can be copied and kept for your records.
Installer, please complete all details below
Owner's Name
Installation Address
Suburb
State
Postcode
Email Address
Installing Company /
RSS / Agent
Installer's Name
Type of Installation
(please circle)
System Model No
Tank Model No
Collector Model No
Collector Serial No's
Electric Booster
(please circle)
Electric Booster Control
(please circle)
Gas Booster
(if installed)
If replacing a water heater, please give details
Brand
If a Rheem unit
Collector Serial No's
Comments
Signature:
Date
INSTALLATION REPORT
Replace
Replace
Replace
Complete
Solar
Electric
Solar
Tank
or Gas
System
1)
2)
Electric continuous
None
Model No
Tank Serial No
1)
2)
Installer:
Telephone Home
Work
Mobile
No. of Stories of Install
Installation Date
Replace
New
Heat
Building
Pump
System Type
Tank Serial No
No of Collectors
3)
Off Peak 1
Off Peak 2
(night)
(night & day)
Timer
Manual Switch
Serial No
Model No
Date of manufacture
3)
Customer:
73
Single
Other
New Install on
Existing Building
Other
(not replacing a unit)
4)
Solar Preheat only
Other
Electric
Gas
4)
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