CV-23 07 00 – HVAC Ductwork Insulation Equipment Identification/Tag: ______ Location:_________________________ A) DUCTWORK INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details Ductwork clean, dry, pressure tested and approved prior to application of insulation. Type and thickness of insulation complies with listed specification requirements for given system. Insulation installed with smooth and even surfaces. Insulation is secured per specification requirements for given insulation type and ductwork width. Insulation seams and joints firmly butted together and covered with 4” tape of same material as jacket. Insulation and vapor barrier continuous through non-rated sleeves. Insulation is butted tightly against the fire stop with butt joints taped in rated construction. Insulation stopped and pointed around access doors and damper operators to allow operation without disturbing insulation or jacket material. Complete vapor barrier provided for all insulated ductwork. Exposed fiberglass insulation covered and sealed at all permanent terminations and at end of work day.
Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO B) VALVE, FITTING & EQUIPMENT INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) 8) 9) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details Fittings, valves, unions, flanges, couplings and specialties insulated with factory molded or built up insulation of the same thickness as adjoining insulation. Where temperatures exceed 150F fittings, valves, unions, flanges, couplings and specialties are covered with fabric reinforcing and mastic. PVC fitting covers may be used where temperatures do not exceed 150 F. PVC fitting covers secured with tack fasteners and 1-1/2” band of mastic over ends, throat, seams or penetrations or for systems requiring vapor barrier, vapor barrier mastic. Group/ Item
CV-23 09 14 – Air Compressors Equipment Identification/Tag: ______ Location:_________________________ Group/Item Group/Task Description Submitted Delivered A MODEL VERIFICATION 1 Manufacturer 2 Model 3 Serial Number 4 Capacity (scfm @ psi) @ @ 5 Receiver capacity (gal) 6 Power / Speed (hp / rpm) 7 Voltage / Phase / Frequency (V / - / Hz) / / / / CHECKLIST GROUP COMPLETE INITIALS: DATE: Group/Item Group/Task Description Response B PHYSICAL CHECKS 1 Unit is free from physical damage. YES NO 2 The air openings are sealed with plastic plugs. YES NO 3 All components present. YES NO 4 Installation and startup manual provided. YES NO 5 Unit tags affixed. YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Group/Item Group/Task Description Response C INSTALLATION 1 Unit secured as required by manufacturer and specifications. YES NO 2 Unit is isolated from the building structure (to reduce vibration and noise) YES NO 3 Adequate clearance around unit for service. YES NO 4 All components accessible for maintenance. YES NO 5 Unit labeled and is easy to see. YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Group/Item Group/Task Description Response D PIPING 1 All piping components have been installed (in the correct order) as required by contract document or manufacturer. YES NO 2 Piping arranged for ease of unit removal. YES NO 3 Piping supported as required by specifications. YES NO 4 Pressure relief valve installed and is operational. YES NO 5 Piping flexible connector installed at unit. YES NO 6 Automatic condensate drain installed and piped to nearest floor drain. YES NO 7 Cartridge filter-silencer with pre and post isolation valves installed in piping for each compressor. YES NO 8 Piping and valves properly checked and free of leaks. YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Group/Item Group/Task Description Response E ELECTRICAL 1 Local disconnect installed in accessible and visible location. YES NO 2 Motor rotation in the proper direction YES NO 3 All electrical connections are tight. YES NO 4 All electrical components are grounded. YES NO 5 Each motor terminal box is connected with a minimum 12", maximum 36" piece of flexible conduit to a fixed junction box. YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE:
CV-23 09 14 – Pneumatic Piping and Devices Equipment Identification/Tag: ______ Location:_________________________ A) PRE-INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details All piping, valves, devices, etc. are clean and free of damage prior to installation. Temporary end caps are provided on piping and fittings until installation. Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO Group/ Item
Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO C) VALVES & CONTROL DEVICES INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) 8) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details All valves are in an upright vertical position with handles in a horizontal position and fully operated without removal or alteration of handle. Isolation valves provided at all equipment connections, main branches and sub-branches, “T” connections, and as necessary for repairing the system as specified in contract documents. Piping purged with oil free compressed air prior to connection to control devices. Pilot positioners provided on all valves where more than one pneumatic operator is controlled in sequence, for all valves 3” and larger, or where required to provide sufficient power. Group/ Item
Pressure gauges provided at damper and valve operators with pilot positioners , transducers, etc. according to Section 23 09 14. Thermometers installed at each point of temperature transmission (sensors) and control, except reheat coils, unless the drawings indicate a thermometer is to be installed. Capped tees installed in air piping at air pressure transducers for connection of calibration equipment. All control devices and boxes mounted on insulated ductwork are mounted over the insulation. Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO D) TESTING & FINALIZATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) 8) 9) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Group/ Item
CV-23 11 00 – Facilities Fuel Piping Equipment Identification/Tag: ______ Location:_________________________ A) PRE-INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details All piping, valves, etc. are clean and free of damage prior to installation. Temporary protective coating is provided on cast iron and steel valves during storage. Temporary end caps are provided on piping and fittings until installation. Contractors installing fuel oil piping in the City of Madison are approved installers by the Madison Fire Department and plans have been submitted and approved by the Madison Fire Department. Welder procedure qualification records (PQR) and welding procedure specifications (WPS) submitted to A/E and DFD.
Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO B) GENERAL PIPING INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details Piping is free to expand and contract without noise or damage to hangers, joints, or the building. Changes in pipe sizes are made with the proper size reducing fittings, reducing elbow or reducing tees, and no bushings are utilized. Group/ Item
Pipe hanger spacing complies with specification requirements. All equipment requiring maintenance is accessible (valves, etc.). Piping allows access to equipment that is part of this system or another system. Piping is not run through any plenums rated for ventilation. Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO C) FUEL OIL PIPING INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO Group/ Item
CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details Double or triple swing joints provided in the pipe lines connected to underground fuel oil tanks, except straight fill lines and test wells, to permit the tanks to settle without impairing the tightness of the pipe connections. Tank fill piping terminated at least two feet from any building wall. Vent pipe pitched to drain toward tank without sags or traps in which liquid may collect. Where two or more tanks are indicated to be vented through a common line, the point of connection between the individual vent lines is not be lower than the top of any fill pipe opening. All vent pipes terminated outside of the building, not less than two feet measured vertically or horizontally from any building opening, not less than twenty five feet from any outside air intake louver, and with a weatherproof and flameproof vent cap or hood. Flexible piping connections installed in supply and return lines at each engine. Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO D) NATURAL GAS PIPING INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO
CV-23 21 13 – Hydronic Piping Equipment Identification/Tag: ______ Location:_________________________ A) PRE-INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details All piping, valves, etc. are clean and free of damage prior to installation. Temporary protective coating is provided on cast iron and steel valves during storage. Temporary end caps are provided on piping and fittings until installation. Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution
Open pipe ends capped at completion of work day. Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO C) VALVE, FITTING & VENT INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details All valves are in an upright vertical position with handles in a horizontal position. All valves can be fully operated without removal or alteration of handle, including provisions for specified insulation thickness of piping.
CV-23 22 13 – Steam and Condensate Heating Piping Equipment Identification/Tag: ______ Location:_________________________ A) PRE-INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details All piping, valves, etc. are clean and free of damage prior to installation. Temporary protective coating is provided on cast iron and steel valves during storage. Temporary end caps are provided on piping and fittings until installation. Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution
Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO C) VALVE, FITTING & VENT INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details All valves are in an upright vertical position with handles in a horizontal position. All valves can be fully operated without removal or alteration of handle, including provisions for specified insulation thickness of piping. Where valves 2-1/2" and larger are located more than 12' above mechanical room floors, valve is installed with stem in the horizontal position and a chain wheel operator is provided.
CV-23 23 00 – Refrigerant Piping Equipment Identification/Tag: ______ Location:_________________________ A) PRE-INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details All piping, valves, etc. are clean and free of damage prior to installation. Temporary end caps are provided on piping and fittings until installation Copper pipe is marked “ACR”. Negative Responses
Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO B) PIPING INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details Piping is free to expand and contract without noise or damage to hangers, joints, or the building. Piping is installed in a manner to ensure that insulation will not contact adjacent surfaces. Changes in pipe sizes are made with the proper size reducing fittings, reducing elbow or reducing tees, and no bushings are utilized. Pipe hanger spacing complies with Section 23 05 29 requirements, including provision of individual hangers within 1’ of each horizontal elbow, valve, etc. All equipment requiring maintenance is accessible (valves, etc.). Piping allows access to equipment that is part of this system or another system. All solder joints are Grade 4 or 5 and have a melting point of 1,250° F. Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO
YES / NO YES / NO YES / NO YES / NO D) VALVE & SPECIAL EQUIPMENT INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details All valves are in an upright vertical position with handles in a horizontal position. All valves can be fully operated without removal or alteration of handle, including provisions for specified insulation thickness of piping. Isolation valves provided at all equipment connections, main branches and sub-branches, “T” connections, and as necessary for repairing the system as specified in contract documents. For circuits 15 tons and over angle pattern filter dryers with replaceable core provided. For circuits below 15 tons straight pattern filter dryers without replaceable core provided. Sight glass, filter dryer, TXV, liquid line solenoid valves are installed as detailed. Charging valves with ¼” SAE brass male flare access ports with finger tight, quick seal caps and 2” long copper extension sections provided.
Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO E) TESTING CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details Piping tested utilizing HFC refrigerant and nitrogen at specified pressures and duration as per specification. All leaks identified during testing have been repaired and test re-done until satisfactory conditions are accomplished.
Test conducted with all piping of tested system or section visible during testing. Following completion of approved leak tests, piping evacuated in accordance with procedures detailed in specification. Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO D) FINALIZATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details System charged with type and quantity of refrigerant per charging procedure detailed in specification. Final refrigerant charge recorded and submitted.
B) PIPING INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) 8) 9) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details Piping is free to expand and contract without noise or damage to hangers, joints, or the building. Piping is installed in a manner to ensure that insulation will not contact adjacent surfaces. All piping pitched upward from heat exchanger to radiator and from heat exchanger to engine. Changes in pipe sizes are made with the proper size reducing fittings, reducing elbow or reducing tees, and no bushings are utilized. Connections between dissimilar pipe materials are made with dielectric fittings. Pipe hanger spacing complies with Section 15 05 29 requirements. All equipment requiring maintenance is accessible (valves, strainers, etc.). Piping allows access to equipment that is part of this system or another system. Open pipe ends capped at completion of work day. Negative Responses
Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO C) VALVE & FITTING INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) 8) 9) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details Heat exchanger is mounted below cylinder head of engine. Radiator surge tank installed 4" above radiator or as recommended by the equipment supplier. Engine surge tank installed 4" above highest engine water outlet piping. All valves are in an upright vertical position with handles in a horizontal position. All valves can be fully operated without removal or alteration of handle, including provisions for specified insulation thickness of piping.
Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO B) CLEANING TREATMENT CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) 8) 9) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details All chemicals added to system according to manufacturer recommendations. Water filter elements removed from the system before starting circulation. Neutralizer agents used on recommendation of system cleaner supplier and approval of Architect/Engineer. Cleaning treatment procedures, metrics and circulation durations follow specification requirements for system type. Open systems flushed for a minimum of one hour before being drained and re-filled. Strainer screens removed, cleaned and replaced after cleaning treatment. Startup screen removed from strainers in suction diffusers.
Low points inspected, sludge removed and flushed with clean water. DFD standard cleaning report completed and submitted. Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO C) FINAL TREATMENT CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details System verified by chemical testing to be free of cleaning chemicals prior to final treatment.
CV-23 31 00 – Ductwork and Casings Equipment Identification/Tag: ______ Location:_________________________ A) GENERAL DUCTWORK INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details Ductwork is clean and free of damage prior to installation. Ductwork is installed in accordance with SMACNA HVAC Duct Construction Standards, Metal and Flexible, 2nd Edition, 1995. Where two different metal ducts meet, the joint is installed in such a manner that metal ducts do not contact each other by using proper seal or compound. No reductions to duct to less than six inches in any dimension and/or aspect ratio greater than 8:1 are present. Duct is pitched toward outside air intakes and drain to outside of building. Solder or seal seams to form watertight joints. All equipment and systems requiring maintenance are accessible (valves, junction boxes, etc.). All seams, joins and penetrations sealed in accordance with SMACNA seal class "A" standards, except transfer ductwork with pressure classification below 2”. All duct openings sealed to maintain duct system cleanliness. Ductwork supported in accordance with SMACNA HVAC Duct Construction Standards, except secure wire method is not utilized. Sheet metal thickness complies with the requirements of Section 23 21 00.
Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO B) SUPPLY DUCTWORK INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details Duct is pitched toward outside air intakes and drain to outside of building. Solder or seal seams to form watertight joints. All seams, joins and penetrations sealed in accordance with SMACNA seal class "A", except transfer ductwork with pressure classification below 2”. Manual balancing damper installed in each branch duct and for each diffuser or grille. Negative Responses
Access doors and clean out doors provided on duct sides of dust collection exhaust ductwork at each change in direction, at junctions with vertical ducts, at devices requiring periodic inspection and maintenance, and not less than every 10 lineal feet of duct, including risers. Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO D) FUME & PERCHLORIC ACID EXHAUST DUCTWORK INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) 8) 9) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details For all rectangular duct and round duct 36 inch diameter and larger, PCD sealant provided at the corrosive side of the gasket.
YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details Turning vanes installed in all rectangular, mitered elbows in accordance with SMACNA standards and/or manufacturer's recommendations. Fire dampers installed in sleeves with retaining angles on both sides of rated partition, with ductwork connections meeting manufacturer requirements. Where it is necessary to set dampers out from the rated wall, install a sleeve extension encased in two hour rated fire proofing insulation. Install an access door at each fire damper, located to permit resetting the damper or replacing the fusible link. Access doors provided in size, location and quantity specified under contract documents, including before and after all duct mounted coils. Pressure relief doors provided on VAV systems to protect ductwork damage in the case of equipment or controls malfunction. Flexible duct connections provided for all connections to rotating or vibrating equipment, including air handling units (unless unit is internally isolated), fans, or other motorized equipment. Flexible duct connections in corrosive environments or fume exhaust systems, provided with a double layer of the Teflon coated fabric. Manual volume dampers are constructed with continuous shafts according to SMACNA Duct Construction Standards Fig. 2-12 and Fig. 2-13. Manual volume damper blades are two gauges thicker than the surrounding duct according to SMACNA Duct Construction Standards Fig. 2-12 and Fig. 2-13. Manual volume damper handles are extended beyond the surface of external duct insulation according to Section 23 33 00. Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO F) FLEXIBLE DUCTWORK INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO
Group/Item Group/Task Description Response F CONTROLS INSTALLATION (if applicable) 1 Thermostat wiring installed and communication verified. YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Group/Item Group/Task Description Response G MECHANICAL STARTUP 1 Unit is clean. YES NO 2 Unit grille attached and is clean. YES NO 3 Light of proper wattage and type installed (if applicable). YES NO 4 System starts and runs without any unusual noise or vibration. YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Group/Item Group/Task Description Response H CONTROLS STARTUP (if applicable) 1 Temperature control sequence verified and acceptable. YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Negative Responses Group/ Item Date Found Found By Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO
CV-23 51 00 – Breechings, Chimneys and Stacks Equipment Identification/Tag: ______ Location:_________________________ A) CONDENSING APPLIANCE VENTS INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details All vents pitched up from equipment to point of termination outside of facility. Hanger spacing complies with specification requirements. Termination of vent is above and/or at least 10’ from any outside air intake, operable window, door, or equipment intake. Vents are leak tight. Drain connection provided at base of exhaust vent and piped to nearest drain. Negative Responses
Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO B) DOUBLE WALL METAL STACKS & BREECHINGS INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) 8) 9) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details Stack, breeching and accessories installed in accordance with minimum clearances for combustibles as specified in UL listing. All breechings pitched up from equipment to chimney or stack. Minimum number of joints utilized in breechings and all connections aligned and smooth internally. Hanger and support spacing complies with specification requirements. Vent dampers provided at draft hood outlet for all natural draft applications. All joints sealed with manufacturer recommended sealants for positive pressure stacks and breechings. Slip joints provided at equipment connections to allow removal of equipment without removal or dismantling of breechings, chimneys, or stacks.
Open breeching and chimney ends capped at completion of work day. Breechings, chimneys and stacks cleaned internally and externally at conclusion of installation. Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO C) REFRACTORY LINED STACKS & BREECHINGS INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) 8) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details
CV-23 52 00 – Fire Tube Boilers Equipment Identification/Tag: ______ Location:_________________________ Group/Item Group/Task Description Submitted Delivered A MODEL VERIFICATION 1 Manufacturer 2 Model 3 Serial Number 4 Total Input / Output Capacity (MBH) / / 5 Gas inlet pressure (psi) 6 Burner motor HP 7 Voltage / Phase / Frequency (V / - / Hz) / / / / CHECKLIST GROUP COMPLETE INITIALS: DATE: Group/Item Group/Task Description Response B PHYSICAL CHECKS 1 Unit is free from physical damage. YES NO 2 The water and gas openings are sealed with plastic plugs. YES NO 3 All components present. YES NO 4 Installation and startup manual provided. YES NO 5 Unit tags affixed. YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Group/Item Group/Task Description Response C INSTALLATION 1 Unit located indoors and protected from freezing temperatures. YES NO 2 Unit not located near an air-moving device. YES NO 3 Proper clearances from combustible surfaces maintained per manufacturer’s instructions and applicable codes. YES NO 4 Installation area free of corrosive elements and flammable materials. YES NO 5 Unit is set on concrete housekeeping pad and is level. YES NO 6 Unit secured as required by manufacturer and specifications. YES NO 7 Equipment location coordinated with piping, ductwork, conduit and equipment of other trades to allow sufficient clearances. YES NO 8 Adequate clearance around unit for service. YES NO 9 All components accessible for maintenance. YES NO 10 Unit labeled and is easy to see. YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Group/Item Group/Task Description Response D VENTILATION AND COMBUSTION AIR SUPPLY 1 Fresh air not taken from areas that contain negative pressure producing devices. YES NO 2 Fresh air supply free of corrosive elements and flammable vapors. YES NO 3 Fresh air openings located correctly with consideration given to the blocking effect of louvers and grilles. YES NO 4 Overall ductwork length and restrictions comply with manufacturer requirements. YES NO 5 Ductwork is the same cross-sectional area as openings. YES NO 6 All ductwork is properly sealed and sloped per manufacturer specifications. YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE:
CV-23 52 00 –Condensing Boilers Equipment Identification/Tag: ______ Location:_________________________ Group/Item Group/Task Description Submitted Delivered A MODEL VERIFICATION 1 Manufacturer 2 Model 3 Serial Number 4 Total Input / Output Capacity (MBH) / / 5 Gas inlet pressure (psi) 6 Voltage / Phase / Frequency (V / - / Hz) / / / / CHECKLIST GROUP COMPLETE INITIALS: DATE: Group/Item Group/Task Description Response B PHYSICAL CHECKS 1 Unit is free from physical damage. YES NO 2 The water and gas openings are sealed with plastic plugs. YES NO 3 All components present. YES NO 4 Installation and startup manual provided. YES NO 5 Unit tags affixed. YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Group/Item Group/Task Description Response C INSTALLATION 1 Unit located indoors and protected from freezing temperatures. YES NO 2 Unit not located near an air-moving device. YES NO 3 Proper clearances from combustible surfaces maintained per manufacturer’s instructions and applicable codes. YES NO 4 Installation area free of corrosive elements and flammable materials. YES NO 5 Unit is set on concrete housekeeping pad and is level. YES NO 6 Unit secured as required by manufacturer and specifications. YES NO 7 Equipment location coordinated with piping, ductwork, conduit and equipment of other trades to allow sufficient clearances. YES NO 8 Adequate clearance around unit for service. YES NO 9 All components accessible for maintenance. YES NO 10 Unit labeled and is easy to see. YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Group/Item Group/Task Description Response D VENTILATION AND COMBUSTION AIR SUPPLY 1 Fresh air not taken from areas that contain negative pressure producing devices. YES NO 2 Fresh air supply free of corrosive elements and flammable vapors. YES NO 3 Fresh air openings located correctly with consideration given to the blocking effect of louvers and grilles. YES NO 4 Overall ductwork length and restrictions comply with manufacturer requirements. YES NO 5 Ductwork is the same cross-sectional area as openings. YES NO 6 All ductwork is properly sealed and sloped per manufacturer specifications. YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE:
13 Pressure and temperature relief valve(s) for correct pressure and temperature installed. YES NO 14 Pressure and temperature relief valve(s) piped with sufficient pipe diameter to drain designed for boiling water. YES NO 15 Drain valve provided. YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Group/Item Group/Task Description Response E STEAM PIPING (IF APPLICABLE) 1 All piping components have been installed (in the correct order) as required by contract document or manufacturer. YES NO 2 Strainer and isolation valve installed. YES NO 3 Proper condensate trap installed. YES NO 4 Pressure relief valve installed prior to heat exchanger for steam supply pressures above maximum recommended pressure ratings for unit. YES NO 5 Safety and pressure relief devices installed in manner to minimize personnel and property damage. YES NO 6 Piping pitched for proper condensate flow. YES NO 7 Piping arranged for ease of unit removal. YES NO 8 Piping supported as required by specifications. YES NO 9 Piping is clean. YES NO 10 Piping and valves properly checked and free of leaks. YES NO 11 Pressure gauges supplied on supply lines. YES NO 12 Piping insulation is complete and installed as per specifications. YES NO 13 All valves and test ports are easily accessible. YES NO 14 Valve tags attached. YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Group/Item Group/Task Description Response F CONTROLS INSTALLATION 1 Control panel accessible and labeled properly. YES NO 2 Remote start and stop wiring installed and communication verified. YES NO 3 Remote status wiring installed and communication verified. YES NO 4 Remote alarm wiring installed and communication verified. YES NO 5 Hot water temperature reset signal verified and programmed. YES NO 6 Actuators installed and calibration verified. YES NO 7 High temperature limit sensor installed and programmed per contract documents. YES NO 8 Steam supply pressure sensor installed and communication verified (steam boilers ONLY). YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Group/Item Group/Task Description Response G MECHANICAL STARTUP 1 System flushed, filled, and air purged. YES NO 2 Manufacturer's startup checklist completed and attached. YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Negative Responses Date Found Found By Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO
AHU – CFM OA-Max 􀂉 YES 􀂉 NO 􀂉 YES 􀂉 NO 􀂉 YES 􀂉 NO AHU – CFM RA-Min 􀂉 YES 􀂉 NO 􀂉 YES 􀂉 NO 􀂉 YES 􀂉 NO AHU – CFM RA-Max 􀂉 YES 􀂉 NO 􀂉 YES 􀂉 NO 􀂉 YES 􀂉 NO AHU – GPM Coil 􀂉 YES 􀂉 NO 􀂉 YES 􀂉 NO 􀂉 YES 􀂉 NO AHU – GPM Coil 􀂉 YES 􀂉 NO 􀂉 YES 􀂉 NO 􀂉 YES 􀂉 NO Fan – CFM 􀂉 YES 􀂉 NO 􀂉 YES 􀂉 NO 􀂉 YES 􀂉 NO Fan - ESP 􀂉 YES 􀂉 NO 􀂉 YES 􀂉 NO 􀂉 YES 􀂉 NO Grille – CFM 􀂉 YES 􀂉 NO 􀂉 YES 􀂉 NO 􀂉 YES 􀂉 NO Grille – CFM 􀂉 YES 􀂉 NO 􀂉 YES 􀂉 NO 􀂉 YES 􀂉 NO Offset – 􀂉 YES 􀂉 NO 􀂉 YES 􀂉 NO 􀂉 YES 􀂉 NO Pump – GPM 􀂉 YES 􀂉 NO 􀂉 YES 􀂉 NO 􀂉 YES 􀂉 NO Pump – GPM 􀂉 YES 􀂉 NO 􀂉 YES 􀂉 NO 􀂉 YES 􀂉 NO VAV – CFM Min 􀂉 YES 􀂉 NO 􀂉 YES 􀂉 NO 􀂉 YES 􀂉 NO VAV – CFM Max 􀂉 YES 􀂉 NO 􀂉 YES 􀂉 NO 􀂉 YES 􀂉 NO Edit and expand Table to match sampling methodology and project Design. Triple duty valves for pumps operated by VFD are 100% open? YES NO Diffusers and grilles with adjustable throw patterns adjusted to match contract documents? YES NO Final ductwork control static pressure setpoint recorded? YES NO Final hydronic control differential pressure setpoint recorded? YES NO VAV box “k” factors recorded YES NO Pump impeller required trimming completed YES NO Conclusion Acceptable Criteria: All points listed are within listed tolerances of design and original recordings and were recorded in accordance with TAB plan and/or NEBB standards. Comments: Observations: Final Status: Accepted Not Accepted Relevant Trend Data Static Pressure Setpoint (VFD fans ONLY), Hydronic Loop Differential Setpoint (VFD pumps ONLY). Witnesses Name Signature
Unoccupied Cooling/Heating (if applicable): Unit # Mode Setpoint Temp. F Space Temp. F Discharge Temp. F Damper Status Valve/Coil Status Approved Steady Y / N Heat Y / N Cool Y / N Occupancy Override (occupancy controlled applications ONLY): Manual Override (Thermostat Switch) Unit # Override Duration, min Approved Y / N Occupancy Sensor Unit # Override Duration, min Min Air Flow, cfm Approved Y / N Constant Volume (if applicable): Unit # Mode Setpoint Temp. F Space Temp. F Setpoint Air Flow cfm Air Flow cfm Discharge Temp. F Damper Status Valve/Coil Status Approved Steady Y / N Heat Y / N Air Y / N Fume Hood Tracking (air valve applications ONLY): Unit # Sash Position Setpoint Air Flow cfm Air Flow cfm Damper Status Approved Steady Y / N Close Y / N Open Y / N Exhaust/Return Air Flow Tracking (if applicable): Unit # Mode Supply Air Flow cfm Setpoint Offset cfm Setpoint Exhaust/Return Air Flow cfm Exhaust/Return Air Flow cfm Damper Status Approved Steady Y / N Air Y / N Supply Air Flow Tracking (air valve applications ONLY): Unit # Steady Air Steady Air Steady Air Total Exhaust Air Flow, cfm Offset Setpoint, cfm Supply Air Flow Setpoint, cfm Supply Air Flow, cfm Space Temperature Setpoint, F Space Temperature, F Discharge Temperature, F Damper Status Valve/Coil Status Approved Y / N Y / N Y / N Y / N Y / N Y / N Differential Pressure Reset: