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Job Name ______________________________________________________________________________
Address ________________________________________________________________________________
______________________________________________________________________________________
City/State
Facility Contact Name _________________________________________ Phone # ____________________
MAKE-UP AIR
1. Kitchen make-up air supply is turned on______Yes______No
2. Type of make-up air
Ceiling Registers
Built into Hood
Ceiling Linear Diffusers
Other
3. If ceiling register or linear diffusers approximate distance from face of hood
_____________________________________________________________
FIRE DAMPER INFORMATION
Ventilator has electric fire damper (GX2 Series)
Ventilator has fuse link fire damper (GX2-FDD Series)
Ventilator does not have a fire damper (GX2-ND Series)
AIR VOLUME READINGS
Push "Start Fan" and take velocities. Record as follows: Exhaust record in the "EX" row, Exhaust at Custom
Air baffles (if applicable) record in the "CA" row, and Make-up Air record in the "MA" row.
A
R I
T I
E
M
N
. O
H
O
O
D
S
E
R
A I
L
N
. O
H
E
X
C
A
M
A
E
X
C
A
M
A
E
X
C
A
M
A
ELECTRIC DAMPER TEST (If equipped):
1. Remove one or more extractors so damper is visible. Push the "START FAN" button.
A. The damper should move to the fully opened position in approx. 1 minute 15 seconds. _____Yes ___No
B. The exhaust fan came on ___Yes ___No
2. Push "STOP FAN" button.
A. The damper should move to the fully closed position in approx. 15 seconds_____Yes_____No
B. The exhaust fan shut off ___Yes ___No
Form No. GX2SUR200
VENTILATOR START-UP INSPECTION REPORT
For Model "GX2-UV" Series Ventilators
Zip
V
E
L
O
C
T I
E I
S
F (
P
M
)
F
R
O
M
L
E
F
T
T
O
R
G I
H
T
O
O
D
S
L
O
T
O
R
M
A
K
E
U -
P
A
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D
S I
C
H
A
R
G
E
Gaylord Representative ____________________________________________________________
Representative Company Name ______________________________________________________
File Number _______________________________________________ Date _________________
CSA Contacted __________________________________________________________________
3. If the "GX2" Series ventilator(s) is interconnected with any "CG3" water wash series, perform the following
test:
A. With the exhaust fan on, open the electrical compartment on the control cabinet and push the "FIRE
TEST" button. The following should occur:
1. Exhaust fan shut off ___Yes ___No
2. Damper fully closed ___Yes ___No
B. At conclusion of the test push the "CANCEL" button. The following should occur:
1. The damper stayed closed ___Yes ___No
2. Fan stayed off ___Yes ___No
C. Push the "START FAN" button. The following should occur:
1. Damper moves to the fully open position ___Yes ___No
2. Exhaust fan comes on ___Yes ___No
INSTALLATION INCLUDES THE FOLLOWING:
Gaylord Rooftop Unit (GRT)
Gaylord Clearair Pollution Control Unit (RSPC)
A
V
E
R
A
G
E
Gaylord Distributor (UDS)
Personnel provided with ventilator technical manual________Yes________No
Inspection Witnessed By (Print Name) ______________________________________________________
Signature ________________________________________________ Date _______________________
Comments ____________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Distribution: WHITE-Gaylord Industries, Inc. YELLOW-Customer
GAYLORD INDUSTRIES 0900 S.W. Avery Street • Tualatin, OR 97062-1149
PHONE:1-503-691-2010 • FAX: 1-503-692-6048 •
The Gaylord "Quencher" Fire Protection System
Wet Chemical Fire Protection System
PINK-Dealer
GOLDENROD-Sales Rep
Litho U.S.A.
email:info@gaylordusa.com
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