JOHNSON CONTROLS
39
FORM 160.81-NOM1
ISSUE DATE: 10/3/2020
1
E. TESTING, EVACUATION AND CHARGING
(Under Johnson Controls Supervision if Unit
Shipped Less Refrigerant or Dismantled)
1. R-134a available for testing ..............................
2. Dry Nitrogen available for testing ......................
3. A high vacuum pump available for evacuation
and dehydration of system ................................
4. R-134a (Supplied by YORK available for
charging) ...........................................................
5. Unit (ready to be) (has been) pressure tested,
evacuated, dehydrated and charged ................
F. CONDITIONS
1. YORK oil for compressor on job .......................
2. Cooling load available for testing and
operating unit ....................................................
3. Personnel available for final wiring connections ..
4. Personnel available for start-up and testing ......
Owner's operating personnel:
Name:
___________________________________________________
Phone Number:
__________________________________________
Name:
___________________________________________________
Phone Number:
__________________________________________
Name:
___________________________________________________
Phone Number:
__________________________________________
With reference to the terms of the above contract, we are requesting the presence of your JCI Authorized Representative at the job site on
______ / ______ / ______
to start the system and instruct operating personnel. Have the JCI representative contact: ____________________________________
We understand that the services of the Johnson Controls Authorized Representative will be furnished in accordance with the contract for a period of time of not
more than _______ consecutive normal working hours, and we agree that a charge of _________ per diem plus travel expenses will be made to Johnson Controls
if services are required for longer than ________ consecutive normal hours or if repeated calls are required, through no fault of Johnson Controls.
Month
Day
Year
Name/Phone
Customer/Contractor Signature:
_______________________________________
Form Completed by:
_______________________________________
_______________________________________
Title:
CONTRACTOR'S RESPONSIBILITIES AND INSTRUCTIONS TO USE FORM
This installation checklist provides a quick way to check if all necessary installation work was completed in accordance with all
applicable installation instructions and when completed, acts as a request for Johnson Controls to furnish start-up supervision.
Complete this form as follows:
1. Fill out the top of the page.
2. Check off each item as required. Cross out (x) items that do not apply.
3. Enter names, initials, and date of the operating personnel who completed the checklist.
4.
Bottom of Form:
Enter the date that the Johnson Controls start-up technician should be at the job site and the name(s)
of the supervisor(s) to be contacted.
5.
Retain one copy in files and send one copy to customer.
