Job Name _________________________________________________________ Check, Test & Start Date ________________
City or Town __________________________________________ State _________________________ Zip ________________
Who is Performing CTS _____________________________________
Equipment Type (Check all that apply)
General Contractor _________________________________________
Essential Items Check of System –
Note:
“No” answers below require notice to installer by memorandum (attached copy.)
□
Closed Loop
□
Open Loop
□
Geothermal
□
Other (specify)______________
Water Source Heat Pump Equipment Check, Test and Start Form
Essential Items Check
A. Voltage Check __________ Volts
Loop Temp. ___________ °F Heating
System Water P.H. Levels __________
Set For ___________ °F Cooling
B. Yes
No
Condition
Comments
□ □
Loop Water Flushed Clean _________________________________________________________________
□ □
Closed Type Cooling Tower _________________________________________________________________
□ □
Water Flow Rate to Heat Pump Balanced ______________________________________________________
□ □
Standby Pump Installed ___________________________________________________________________
□ □
System Controls Functioning _______________________________________________________________
□ □
Outdoor Portion of Water System Freeze Protected ______________________________________________
□ □
Loop System Free of Air ___________________________________________________________________
□ □
Filters Clean ____________________________________________________________________________
□ □
Condensate Traps Installed _________________________________________________________________
Note:
“No” answers below require notice to installer by memorandum (attached copy.)
□ □
Outdoor Air to Heat Pumps: ________________________________________________________________
□ □
Other Conditions Found: ___________________________________________________________________
This form must be completed and submitted within ten (10) days of start-up to comply with the terms of the Daikin warranty. Forms should
be returned to Daikin Warranty Department.
Installation Data
Please include any suggestions or comments for Daikin Applied: ___________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Above System is in Proper Working Order
Note:
This form must be filled out and sent to the warranty administrator
before any service money can be released.
Date
Signature for Sales Representative
Signature for Customer
For Internal Use
Release:
SM ________________________
CTS
________________________
T
________________________
Service Manager Approval
Date
Form WS-CTS-00.01 (Rev. 4/14)
IM 447-11
32
www.DaikinApplied.com
