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Dear Installer / Customer
A copy of this installation report for the heat pump is to be attached to an STC Assignment Form (where
applicable) as proof of installation. It can be copied and kept for your records. An electronic version may be
provided by the installer instead.
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
Electric Booster
(please circle)
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 System
Tank
or Gas
Electric continuous
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
Off Peak 1
Off Peak 2
(night)
(night & day)
Model No
Date of manufacture
3)
Customer:
49
Single
Other
New Install on
Existing Building
Other
(not replacing a unit)
Other
Electric
Gas
4)
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