Site Information

Customer name (name on electric bill):

Customer electric utility account number:

Address: 

City: State: Zip: 

Design

Type of installation: Replacement New system - existing home New system - new home

AC only Heat only AC & heat

Area of zone served by unit: sq ft # of units in home:

Is the unit self-contained, or is fan/airflow provided by external device (furnace)?

Heat gain method: Manual J v7 Manual J v8 None Other:

Duct design method: Manual D None Other:

Equipment specification method: Manual S OEM recommendation Other:

Latent heat gain: BTUh Sensible heat gain: BTUh

Total heat gain: BTUh Design airflow: CFM

Duct design static pressure: IWC Design heat loss: BTUh

Equipment

Condenser Manufacturer: Model: 

Serial number: 

Evaporator Manufacturer: Model: 

Serial number: 

System Metering device: TXV Fixed orifice Other:

Refrigerant: R-22 R-410a Other:

Fan Motor Type: Fixed speed (e.g. PSC) Variable (e.g. ECM/ICM) Other:

Cooling Latent Capacity: BTUh ARI EER/SEER: 

Sensible Capacity: BTUh ARI Ref #:

Total Capacity: BTUh

Heating HSPF:

At 17oF Capacity: BTUh COP:

At 47oF Capacity: BTUh COP:

Previous equipment - for replacements only

Cooling Total capacity: Btuh ARI EER/SEER: 

Heating HSPF:

At 17oF Capacity: BTUh COP:

At 47oF Capacity: BTUh COP:

ENERGY STAR in Cooperation with ABC Electric Company

Installation Commissioning Report for Central AC and Heat Pump
Equipment - continued

Does capacity meet requirement of 95-115% (or up to 125% for heat pumps with heat dominated requirements)

of calculated load or the next nominal size? Yes No

Refrigerant Tests - run system for 15 minutes before testing

Date: Outdoor ambient temp. (at condenser):

o

F DB

Time of test: Outdoor relative humidity - optional:

Barometric pressure - optional:

Air temperatures measured in duct near evaporator (not in conditioned building space):

Cooling Mode Return o

F DB oF WB

Supply o

F DB oF WB

Heating Mode Return o

F DB

Supply o

F DB

Liquid line pressure: psi Liquid line temp.: o

F DB

Suction line pressure: psi Suction line temp.: o

F DB

Refrigerant Calculations Condenser sat. temp. (from liquid pressure):

o

F DB

Evaporator sat. temp. (from suction pressure):

o

F DB

Subcooling (condensing temp. - liquid line temp.):

o

F DB

Superheat (suction line temp. - evaporating temp.):

o

F DB

For TXV

OEM subcooling goal: o

F DB

Subcooling deviation (subcooling - subcooling goal):

o

F DB

For Fixed Orifice

Superheat goal (from superheat lookup tables, based on outdoor ambient and return air wet bulb temps.):

o

F DB

Superheat deviation (superheat goal - superheat):

o

F DB

Does system meet requirement of subcooling within ±3oF or superheat within ±5oF of goal? Yes No

Electrical Measurements - taken at time of refrigerant tests

Evaporator/air handler fan: amps volts watts

Condenser fan: amps volts watts

Compressor: amps volts watts

Electrical Requirements

Does system meets requirements of ACCA QI 4.3? Yes No

Air Flow Tests

Date: Outdoor ambient temp. (at condenser):

o

F DB

Time of test: Outdoor relative humidity - optional:

Barometric pressure - optional:

Measured air volume at evaporator: CFM

AC & Heat Pump Installation Commissioning Report (Page 2 of 3)
Air Flow Tests - continued

Test peformed in heating or cooling mode? Heating Cooling

Static pressure Return Static: IWC Measurement location:

Supply Static: IWC Measurement location:

Measurement method used: TrueFlow Pressure matching (with Duct Blaster) Anemometer

Fan Curve Temperature split (heating only) Other:

Speed Setting If fixed Low Med-Low Med Med-High High CFM (at 0.5 IWC):

If variable Fan set for CFM/ton

Does air flow meet requirement of 350-450 cfm or within range recommended by OEM? Yes No

Duct Leakage

Initial Test Date: Time:

Final Test Date: Time:

Test method used: Duct Blaster Blower Door Subtraction Other:

Existing system duct leakage: CFM

Post Installation duct leakage: CFM Leakage % reduction ([existing-post]/existing):

Total % leakage (post leakage/design flow): OR (post leakage/measured flow):

Does duct leakage meet one of the following requirements:

 No more than 20% of total air flow

 A reduction of 50% or more from the initial measurement

 Leakage from ducts inside the thermal envelope is no more than 10% of total air flow

 No more than 6% of total air flow from ducts outside the thermal envelope

 Less than 4 CFM leakage to outdoors per 100 square feet of conditioned floor area

System Controls

Does system meets requirements of ACCA QI 4.6? Yes No

System Documentation & Owner Education

Copies of this report and OEM manuals left with owner? Yes No

Demonstrated system for owner? Yes No

Contractor/Technician Information

Technician name:

Company:

Address 1: 

Address 2: 

City: State: Zip: 

Phone/Email: 

Technician signature: 

Please send completed forms to: System Implementer, 123 Main St, Town, ST, 01234, FAX 555-123-4567

AC & Heat Pump Installation Commissioning Report (Page 3 of 3)

existing

homes:

new 

construction:
Site Information

Customer name (name on electric bill):

Customer electric utility account number:

Address: 

City: State: Zip: 

Design

Type of installation: Replacement New system - existing home New system - new home

AC only Heat only AC & heat

Area of zone served by unit: sq ft # of units in home:

Heat gain method: Manual J v7 Manual J v8 None Other:

Duct design method: Manual D None Other:

Equipment specification method: Manual S OEM recommendation Other:

Latent Heat Gain: BTUh Sensible Heat Gain: BTUh

Total Heat Gain: BTUh Design Airflow: CFM

Duct Design Static Pressure: IWC Design heat loss: BTUh

Equipment - AC

Condenser Manufacturer: Model: 

Serial number: 

Evaporator Manufacturer: Model: 

Serial number: 

System Metering device: TXV Fixed orifice Other:

Refrigerant: R-22 R-410a Other:

Fan Motor Type: Fixed speed (e.g. PSC) Variable (e.g. ECM/ICM) Other:

Speed setting If fixed Low Med-Low Med Med-High High CFM (at 0.5 IWC):

If variable Fan set for CFM

Latent Capacity: BTUh ARI EER/SEER: 

Sensible Capacity: BTUh ARI Ref #:

Total Capacity: BTUh

Previous equipment - for replacements only

Total capacity: Btuh ARI EER/SEER: 

Does capacity meet requirement of 95-115% of calculated load or the next nominal size? Yes No

ENERGY STAR in Cooperation with ABC Electric Company

Installation Commissioning Report for Central AC and Furnace
Equipment - Furnace

Manufacturer: Model: 

Serial number: AFUE:

Gross capacity: Btuh Net capacity: Btuh

Previous equipment - for replacements only

Gross capacity: Btuh Net capacity: Btuh

Fuel type: Gas Oil Propane Other:

Sealed combustion? Yes No

Fan Motor Type: Fixed speed (e.g. PSC) Variable (e.g. ECM/ICM) Other:

Speed Setting If fixed Low Med-Low Med Med-High High CFM (at 0.5 IWC):

If variable Fan set for CFM

Does capacity meet requirement of 100-140% of calculated load or the next nominal size? Yes No

Refrigerant Tests - run system for 15 minutes before testing

Date: Outdoor ambient temp. (at condenser):

o

F DB

Time of test: Outdoor relative humidity - optional:

Barometric pressure - optional:

Air temperatures measured in duct near evaporator (not in conditioned building space):

Cooling Mode Return o

F DB oF WB

Supply o

F DB oF WB

Liquid line pressure: psi Liquid line temp.: o

F DB

Suction line pressure: psi Suction line temp.: o

F DB

Refrigerant Calculations Condenser sat. temp. (from liquid pressure):

o

F DB

Evaporator sat. temp. (from suction pressure):

o

F DB

Subcooling (condensing temp. - liquid line temp.):

o

F DB

Superheat (suction line temp. - evaporating temp.):

o

F DB

For TXV

OEM subcooling goal: o

F DB

Subcooling deviation (subcooling - subcooling goal):

o

F DB

For Fixed Orifice

Superheat goal (from superheat lookup tables, based on outdoor ambient and return air wet bulb temps.):

o

F DB

Superheat deviation (superheat goal - superheat):

o

F DB

Does system meet requirement of subcooling within ±3oF or superheat within ±5oF of goal? Yes No

AC & Furnace Installation Commissioning Report (Page 2 of 4)
Electrical Measurements - taken at time of refrigerant tests

Evaporator/air handler fan: amps volts watts

Condenser fan: amps volts watts

Compressor: amps volts watts

Electrical Requirements

Does system meets requirements of ACCA QI 4.3? Yes No

Air Flow Tests

Date: Outdoor ambient temp. (at condenser):

o

F DB

Time of test: Outdoor relative humidity - optional:

Barometric pressure - optional:

Measured air volume at evaporator: CFM

Test peformed in heating or cooling mode? Heating Cooling

Static pressure Return Static: IWC Measurement location:

Supply Static: IWC Measurement location:

Measurement method used: TrueFlow Pressure matching (with Duct Blaster) Anemometer

Fan Curve Temperature split (heating only) Other:

Does air flow meet requirement of 350-450 cfm or within range recommended by OEM? Yes No

Duct Leakage

Initial Test Date: Time:

Final Test Date: Time:

Test method used: Duct Blaster Blower Door Subtraction Other:

Existing system duct leakage: CFM

Post Installation duct leakage: CFM Leakage % reduction ([existing-post]/existing):

Total % leakage (post leakage/design flow): OR (post leakage/measured flow):

Does duct leakage meet one of the following requirements:

 No more than 20% of total air flow

 A reduction of 50% or more from the initial measurement

 Leakage from ducts inside the thermal envelope is no more than 10% of total air flow

 No more than 6% of total air flow from ducts outside the thermal envelope

 Less than 4 CFM leakage to outdoors per 100 square feet of conditioned floor area

AC & Furnace Installation Commissioning Report (Page 3 of 4)

existing

homes:

new 

construction:
Gas Combustion Test

Altitude derating factor (from site elevation):

Return air: o

F DB Supply air: oF DB

Orifice size: Manifold pressure: psi

Gas meter test dial size:

Gas meter seconds for one revolution of meter: Low: High:

Gas combustion test calculations

Gas rate (from meter lookup tables): Low speed: High speed:

Actual firing rate: Low speed: High speed:

Percent: Percent:

Temperature rise: Low speed: o

F High speed: oF

Combustion Analyzer - required for oil systems, optional for other fuels

O2: Stack temperature: o

F Efficiency:

CO: Draft pressure: psi

System Controls

Does system meets requirements of ACCA QI 4.6? Yes No

System Documentation & Owner Education

Copies of this report and OEM manuals left with owner? Yes No

Demonstrated system for owner? Yes No

Contractor/Technician Information

Technician name:

Company:

Address 1: 

Address 2: 

City: State: Zip: 

Phone/Email: 

Technician signature: 

Please send completed forms to: System Implementer, 123 Main St, Town, ST, 01234, FAX 555-123-4567

AC & Furnace Installation Commissioning Report (Page 4 of 4)