© 1995-2009 Energy Saving Products Ltd.
Job Name
Job Location
Distributor/Supplier
Contact Name
Contact Name
Phone Number
City, State
Fax Number
Zip Code
Elevation
Phone Number
Design Temp. (Heating/Cooling)
Fancoil Model
Voltage
Fancoil Serial
E.A.T.
(DB/WB)
L.A.T.
(DB/WB)
L.A.T.
First Outlet
L.A.T.
Last Outlet
Fancoil Location
Supply Duct Size
Plenum Location
Return Duct Size
Return Air Location
Fresh Air Duct Size
Plenum Length
Insulated
R-Value
Distance to First Elbow/Tee
R-Value
Number Of 10' AFD's
Number Of Other AFD's
Average Length Of Others
Model
E.W.T
% Glycol
Coil Size
Serial
L.W.T
Circ. Pump
Lines
(Size/Length)
Model
E.W.T
% Glycol
Lines
(Size/Length)
Serial
L.W.T
Circ. Pump
Model
Suction Press.
Siteglass
Serial
Liquid Press.
Moisture
Outdoor Make
Suction Temp.
Outdoor E.A.T.
Outdoor Model
Liquid Temp.
Outdoor L.A.T.
Insulated
Insulated
Filter-Drier
Insulated
Line-set
(Length/Height)
Expansion Valve Model
P-Trap
Hard Start Kit
Hot Gas BP
Delay Timer
Notes:
Location Of TXV Bulb
Location Of Anti-Ice Control
Location Of Equalizer Line
Expansion Valve Size
Extra Insulation Over Ductwork
Cooling Information
(Chilled Water)
Refrigerant Information
(AC, Heat Pump)
E.A.T.
R/A Grill
System Information
Ductwork Information
Total # Of 2" Vents
If More Than One Fancoil Is Present On This Job, Please Indicate Which One:
Installing Contractor
Total # Of 15' AFD's
Address
Fax Number
PWM
Static Plate Installed
Dip Switch Setting
Yes
No
Filter
Clean
Dirty
Job Number
Issue
Date Installed
Heating
Cooling
Airflow
Amperage
Static Press.
Blower Compartment
18" from Supply
Static Press.
Airflow
Watts
Attic
Crawlspace
Conditioned Space
(Electric Strip, Hot Water)
Heating Information
6 Row
4 Row
Bubbles
Clear
Dry
Wet
Outdoor Amps
Conditioned Space
Crawlspace
Attic
Conditioned Space
Crawlspace
Attic
(HE Vents = Two 2" Vents)
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
Date
Job Information
Service and Performance Form
Module SRV Service and Performance Form (1/2)
Module SRV
Service and Performance Form (1/2)
