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Appendix B, Page B-7
UV Start-Up Inspection and Test Report
Facility Name _________________________________ Certified Service Agency (CSA) Company Name
Address ______________________________________ ____________________________________________
City _____________________State _____ Zip _______ CSA Print Name ______________________________
Facility Contact Name __________________________ Signature ___________________________________
Facility Contact Phone # ________________________
Facility E-Mail ________________________________
This Report is for Ventilator: ___________________________________________________________________
Overview
This UV Start Up Inspection and Test Report must be performed by a Gaylord Certified Service Agency (CSA).
UV Lamp Modules are shipped separate from the Ventilator to a CSA for installation, and to perform this UV
Start-Up Inspection and Test. CSA, complete this form for each Ventilator section. Allow about one hour for
each Ventilator section.
Important Note: Before this UV Start-Up Inspection and Test can be performed, the Ventilator Start-Up
Inspection Report must be completed, and all Fire Protection Systems installed, certified and signed off by the
Fire Marshall.
Installation of UV Lamp Modules
1. Check that all XGS Extractors are properly installed. ................................................................. ____ Yes ____No
2. Open the UV Module Access Doors and slide in the UV Lamp Modules.
3. Once installed, connect the Lamp Ballast Connectors to the UV Lamp Modules.
4. Close the UV Module Access Doors and latch.
UV Safety Interlock Test for Extractors
1. Set the Safety Interlock Pressure Switches in accordance with the Gaylord Installation, Operation, and
Maintenance Manual. Once the Pressure Switches have been set proceed to step 2.
Pressure Switches have been set. ................................................................................................... ____ Yes ____No
2. Double check to make sure all XGS Extractors are in place. Start the exhaust fan. The green UV System
Status light should come on. ........................................................................................................... ____ On ____ Off
If the system fails to come on refer to the UV System Troubleshooting section of the Gaylord Installation,
Operation, and Maintenance Manual for ELXC and ELXC-UVi Series Ventilators.
3. With the exhaust fan on, open the Extractor Access Door and remove the left end Extractor, observe the
Status Light, and replace the extractor. Continue the test by removing the middle and then the right end
Extractor. With any one of the three Extractors removed the system should de-activate immediately and
the red UVi System Standby light should come on.
a) Left end Extractor removed, UVi System Standby light should be on. ............................... ____ On ____ Off
b) Middle Extractor removed, UVi System Standby light should be on. ................................. ____ On ____ Off
c) Right end Extractor removed, UVi System Standby light should be on. ............................. ____ On ____ Off
If the light does not come on refer to the UV System Troubleshooting section of the Gaylord Installation,
Operation, and Maintenance Manual for ELXC and ELXC-UVi Series Ventilators.
d) All Extractors replaced and Extractor Access Door Closed. ................................................ ____ Yes ____ No
Ventilator Start-Up Inspection And Tests - cont.
For Gaylord Model ELXC-UVi Series Ventilators
Date of Start-Up ______________________________
Gaylord File Number __________________________
B-7
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