ATT_4_-_Functional_Comissioning_Reports_-_Combined_Files_PDF_Pre_Function_03-30-15.pdf
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- Attached to
- Bridger-Teton NF Supervisors/Jackson Ranger District Office Construction Project Federal contract opportunity
- Solicitation number
- AG-02NV-S-15-0024
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ATT 4 - Functional Commissioning Reports
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PRE-FUNCTIONAL TEST CHECKLIST REPORT LOG
Report ID: Component / System Description Test Date Accepted Remarks / Issues PFC-AS-1-Pump "AS-1" Air Separator
PFC-BSB-1-Thru BSB 17 Branch Selector Box "BSB-1 Thru BSB-17" Branch Selector Box
All Branch selectors need a Pre Function forms for each box
PFC - DX-1 Duct Free Split "DX-1" Duct Free Split
PFC - DX-2 Duct Free Split "DX-2" Duct Free Split
PFC-EWH-1 Electric Wall Heaters
"EWH-1" Electric Wall Heaters Stairs
PFC-EWH-2 Electric Wall Heaters
"EWH-2" Electric Wall Heaters Stairs
PFC-EWH-3 Electric Wall Heaters
"EWH-3" Electric Wall Heaters Stairs
PFC-EWH-4 Electric Wall Heaters
"EWH-4" Electric Wall Heaters Chase
PFC-FC-1 thru FC-24 Fan Coil Unit "FC-1 thru FC-24 " Fan Coil Units
All Fan coil units need an Pre Function form completed. Minimum of (4) Fan coils will be tested for Functional Testing
PFC-HR-1 Water Source Heat recovery Units "HR-1" Water Source Heat recovery Units
PFC-HR-2 Water Source Heat recovery Units "HR-2" Water Source Heat recovery Units
PFC-ERV-1 thru ERV-4 Energy Recovery Units "ERV-1 thru ERV-4" Energy Recovery Units
All ERV's need their own Pre‐Function form completed
PFC-P-1 Geo-Thermal Pumps "P-1" Geo-thermal Pumps
Project Title: Bridger Teton Supervisor and Jackson Ranger District Office SI Project #:J14-003A 1 of 2
AG-02NV-S-15-0024 Bridger-Teton SO/District Ranger Building Construction Project Attachment 4
PRE-FUNCTIONAL TEST CHECKLIST REPORT LOG
Report ID: Component / System Description Test Date Accepted Remarks / Issues
PFC-P-2 Geo-Thermal Pumps "P-2" Geo-thermal Pumps
PFC-P-3 Geo-Thermal Pumps "P-3" Geo-thermal Pumps
PFC-P-4 Geo-Thermal Pumps "P-4" Geo-thermal Pumps
PFC - BAS Building Automation System BAS Building Automation System
PFC - LC lighting Controls Lighting Controls
Project Title: Bridger Teton Supervisor and Jackson Ranger District Office SI Project #:J14-003A 2 of 2
PRE-FUNCTIONAL CHECKLIST
Project Title: B-T Supervisor's office Jackson Ranger Dist.
SI Project #: J14-003A Forest Service 1 of 3 Equipment ID: AS-1
PROJECT: EQUIPMENT ID:
PROJECT #: LOCATION:
REPORT ID:
1. Submittals and Approvals
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
B-T Supervisor's Office Jackson Ranger Dist AS-1
J14-003A Forest Service Geo-Thermal Loop Mech. Rm.
PFC - AS-1- Air Separator DATE:
Approvals: This filled-out checklist has been reviewed. Its completion is approved with the exceptions noted.
Commissioning Authority Owner's Representative
The above equipment and systems integral to them are complete and ready for functional testing. The checklist items are complete and have been checked off only by parties having direct knowledge of the event, respective to each responsible contractor. This Pre-Functional Performance Checklist is submitted for approval, subject to an attached list of outstanding items yet to be completed. A Statement of Correction will be submitted upon completion of any outstanding areas. None of the outstanding items preclude safe and reliable functional tests being performed.
General Contractor Mechanical Contractor
Electrical Contractor TAB Contractor
Temperature Controls Contractor Certified Start-up Technician
SI Project #: J14-003A Forest Service 2 of 3 Equipment ID: AS-1
2. Documentation Verification Check each item as verified and initial. Explain deficiencies under Notes.
Y / N Contractor Initial Notes
3. Physical Installation and Inspection Checks Check each item as verified and initial. Explain deficiencies under Notes.
Y / N Contractor Initial Notes
Pre-functional checklist items are to be completed as part of startup & initial checkout, preparatory to functional testing.
· This checklist is not intended to take the place of the manufacturer’s recommended checkout and startup procedures or report.
· Items that do not apply shall be noted with the reasons on this form (N/A = not applicable, BO = by others).
· Contractors assigned responsibility for sections of the checklist shall be responsible to see that checklist items by their subcontractors are completed and checked off.
Check Manufacturer’s cut sheets Performance data (pump curves, coil data, etc.)
Installation and startup manual and plan Sequences and control strategies Operation & Maintenance manuals
Check General Installation Permanent labels affixed
Serial#:___________________
Manufacture:______________ Model Number:_____________
Pump & Plumbing Air Separator installed Correctly Strainers in place and clean if needed
Air Vent attached
Equipment Installed Per Specifications for given trade Drain / Hose bib attached per I.O.M.
Piping and Gaskets secure no leaks
Pipe fittings complete & pipes properly supported Pipes properly insulated All connections tight Shut off valves / Isolation valves in place Instrumentation installed according to specification (thermometers, pressure gages, etc.)
Pumps Installed Correctly Per Air-separator Instructions
SI Project #: J14-003A Forest Service 3 of 3 Equipment ID: AS-1
Y / N Contractor Initial Notes
4. Notes Refer to Notes under individual line items.
Note
Check
TAB
Installation of system and balancing devices allowed balancing to be completed following specified contract documents
Final Startup report completed with this checklist attached Safeties installed and safe operating ranges for this equipment provided to the commissioning agent
END OF CHECKLIST
Description
PROJECT: EQUIPMENT ID:
PROJECT #: LOCATION:
REPORT ID:
1. Submittals and Approvals
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
B-T Supervisor's Office Jackson Ranger Dist BAS
J14-003A Forest Service
PFC - BAS - Building Automation Sys. DATE:
Approvals: This filled-out checklist has been reviewed. Its completion is approved with the exceptions noted.
Commissioning Authority Owner's Representative
Pre-functional checklist items are to be completed as part of startup & initial checkout, preparatory to functional testing.
The above equipment and systems integral to them are complete and ready for functional testing. The checklist items are complete and have been checked off only by parties having direct knowledge of the event, respective to each responsible contractor. This Pre-Functional Performance Checklist is submitted for approval, subject to an attached list of outstanding items yet to be completed. A Statement of Correction will be submitted upon completion of any outstanding areas. None of the outstanding items preclude safe and reliable functional tests being performed.
General Contractor Mechanical Contractor
Electrical Contractor TAB Contractor
Temperature Controls Contractor Certified Start-up Technician
Project Title : B-T Supervisor's Office Jackson Ranger Dist.
SI Project No: J14-003A 1 of 3 Equipment ID: BAS
2. Documentation Verification Check each item as verified and initial. Explain deficiencies under Notes.
Y / N Contractor Initial Notes
3. Physical Installation and Inspection Checks Check each item as verified and initial. Explain deficiencies under Notes.
Y / N Contractor Initial Notes
All control actuator wires connected to existing control system
· This checklist is not intended to take the place of the manufacturer’s recommended checkout and startup procedures or report.
· Items that do not apply shall be noted with the reasons on this form (N/A = not applicable, BO = by others).
Operation & Maintenance manuals
· Contractors assigned responsibility for sections of the checklist shall be responsible to see that checklist items by their subcontractors are completed and checked off.
Check Manufacturer’s cut sheets Installation and startup manual and plan Sequences and control strategies
Valves, and Actuators
Maintenance access acceptable for unit and components
Clean up of equipment completed per contract documents
Check General Installation
Proper panel mountings
Panels properly grounded Battery backup in place and operable
All control valves wires connected to existing control system
All control actuators installed in ducts properly
General appearance good, no apparent damage
Layout and location of control panels matches drawings Wiring labeled inside panels (to controlled components) Controlled components labeled/tagged BAS connection made to labeled terminal(s) Shielded wiring used on electronic sensors 110 volt AC power available to panel
Environmental conditions according to manufacturer’s Date and time correct
Instrumentation installed according to specification Thermal insulation properly installed and according to specification
All control valves installed in piping properly That will be monitored
Project Title : B-T Supervisor's Office Jackson Ranger Dist.
SI Project No: J14-003A 2 of 3 Equipment ID: BAS
Y / N Contractor Initial Notes
4. Testing and Operational Checks Check each item as verified and initial. Explain deficiencies under Notes.
Y / N Contractor Initial Notes
5. Notes Refer to Notes under individual line items.
Note
Check
Power disconnects in place and labeled All electric connections tight Proper grounding installed for components and unit Safeties in place and operable All control devices and wiring complete
Solenoid control valves in place
Electrical and Controls Sensors are properly calibrated
Check General Installation
Verify all field wiring test clear of short circuits.
Verify all field wiring test clear of earth grounds.
Verify panel trouble, supervisory, and alarm conditions Sensors are properly calibrated System voltage readings are correct
Verify all required I/O points function from the UMCS system
Final Startup report completed with this checklist attached Safeties installed and safe operating ranges for this equipment provided to the commissioning agent
END OF CHECKLIST
Description
Project Title : B-T Supervisor's Office Jackson Ranger Dist.
SI Project No: J14-003A 3 of 3 Equipment ID: BAS
Project Title: B-T Supervisor's Office Jackson Ranger Dist.
Project #:J14-003A Forest Service 1 of 3 Equipment ID:BSB-____
PROJECT: EQUIPMENT ID:
PROJECT #: LOCATION:
REPORT ID:
1. Submittals and Approvals
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Temperature Controls Contractor Certified Start-up Technician
Approvals: This filled-out checklist has been reviewed. Its completion is approved with the exceptions noted.
Commissioning Authority Owner's Representative
The above equipment and systems integral to them are complete and ready for functional testing. The checklist items are complete and have been checked off only by parties having direct knowledge of the event, respective to each responsible contractor. This Pre-Functional Performance Checklist is submitted for approval, subject to an attached list of outstanding items yet to be completed. A Statement of Correction will be submitted upon completion of any outstanding areas. None of the outstanding items preclude safe and reliable functional tests being performed.
General Contractor Mechanical Contractor
Electrical Contractor TAB Contractor
B-T Supervisors Office Jackson Ranger Dist BSB-
J14-003A Forest Service
PFC -BSB- Branch Selector Boxes DATE:
Project #:J14-003A Forest Service 2 of 3 Equipment ID:BSB-____
2. Documentation Verification Check each item as verified and initial. Explain deficiencies under Notes.
Y / N Contractor Initial Notes
3. Physical Installation and Inspection Checks Check each item as verified and initial. Explain deficiencies under Notes.
Y / N Contractor Initial Notes
Casing condition good: no dents or leaks, Piping Connections between Branch selector are tight and in Maintenance access acceptable for unit and components Unit installed per manufactures recomendations
Serial #:____________________ Model #:_____________________ Manufacture:_________________
Instrumentation installed according to mnfg. specification Vibration isolation equipment installed & released from shipping locks
Check General Installation Permanent labels affixed
Sequences and control strategies
Pre-functional checklist items are to be completed as part of startup & initial checkout, preparatory to functional testing.
· This checklist is not intended to take the place of the manufacturer’s recommended checkout and startup procedures or report.
· Items that do not apply shall be noted with the reasons on this form (N/A = not applicable, BO = by others).
Operation & Maintenance manuals
Manufacturer’s cut sheets Performance data (fan curves, coil data, etc.)
Installation and startup manual and plan
· Contractors assigned responsibility for sections of the checklist shall be responsible to see that checklist items by their subcontractors are completed and checked off.
Check
Project #:J14-003A Forest Service 3 of 3 Equipment ID:BSB-____
Y / N Contractor Initial Notes
4. Notes Refer to Notes under individual line items.
Note
END OF CHECKLIST
Description
TAB
Installation of system and balancing devices allowed balancing to be completed following specified contract
Final Startup report completed with this checklist attached Safeties installed and safe operating ranges for this equipment provided to the commissioning agent
Electrical and Controls Check
Motor Voltage - Rated:________Actual:________ Motor Amps - Rated:________ Actual:________
Power disconnects in place and labeled All electric connections tight Proper grounding installed for components and unit Safeties in place and operable All control devices and wiring complete
SI Project #: J14-003A Forest Service 1 of 3 Equipment ID: DX-1
PROJECT: EQUIPMENT ID:
PROJECT #: LOCATION:
REPORT ID:
1. Submittals and Approvals
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
The above equipment and systems integral to them are complete and ready for functional testing. The checklist items are complete and have been checked off only by parties having direct knowledge of the event, respective to each responsible contractor. This Pre-Functional Performance Checklist is submitted for approval, subject to an attached list of outstanding items yet to be completed. A Statement of Correction will be submitted upon completion of any outstanding areas. None of the outstanding items preclude safe and reliable functional tests being performed.
General Contractor Mechanical Contractor
Electrical Contractor TAB Contractor
B-T Supervisor's Office Jackson Ranger Dist DX-1
J14-003A Forest Service Comm Room 127
PFC - DX-1 Duct Free Split DATE:
Temperature Controls Contractor Certified Start-up Technician
Approvals: This filled-out checklist has been reviewed. Its completion is approved with the exceptions noted.
Commissioning Authority Owner's Representative
SI Project #: J14-003A Forest Service 2 of 3 Equipment ID: DX-1
2. Documentation Verification Check each item as verified and initial. Explain deficiencies under Notes.
Y / N Contractor Initial Notes
3. Physical Installation and Inspection Checks Check each item as verified and initial. Explain deficiencies under Notes.
Y / N Contractor Initial Notes
Y / N Contractor Initial Notes
Manufacturer’s cut sheets Performance data (fan curves, coil data, etc.)
Installation and startup manual and plan
· Contractors assigned responsibility for sections of the checklist shall be responsible to see that checklist items by their subcontractors are completed and checked off.
Check
Sequences and control strategies
Pre-functional checklist items are to be completed as part of startup & initial checkout, preparatory to functional testing.
· This checklist is not intended to take the place of the manufacturer’s recommended checkout and startup procedures or report.
· Items that do not apply shall be noted with the reasons on this form (N/A = not applicable, BO = by others).
Operation & Maintenance manuals
Instrumentation installed according to specification
Piping hooked up and properly connected
Vibration isolation equipment installed & released from shipping locks
Check General Installation Permanent labels affixed
Indoor Unit to be mounted level
Piping insulation
Power disconnects in place and labeled All electric connections tight Proper grounding installed for components and unit Safeties in place and operable
Casing condition good: no dents or leaks, door gaskets Maintenance access acceptable for unit and components Clean up of equipment completed per contract documents
Low Ambient Control / Crank case Heater installed Dryer installed
All control devices and wiring complete
Wind Baffle Indoor unit condensate connection installed
Electrical and Controls Check
Serial #:_________________ Model #:_________________ Manufacture:______________
Motor Volts - Rated:________ Actual:_________ Motor Amps- Rated:________ Actual:_________
TAB
Installation of system and balancing devices allowed balancing to be completed following specified contract
Final
SI Project #: J14-003A Forest Service 3 of 3 Equipment ID: DX-1
4. Notes Refer to Notes under individual line items.
Note
Startup report completed with this checklist attached Safeties installed and safe operating ranges for this equipment provided to the commissioning agent
END OF CHECKLIST
SI Project #: J14-003A Forest Service 1 of 3 Equipment ID: DX-2
PROJECT: EQUIPMENT ID:
PROJECT #: LOCATION:
REPORT ID:
1. Submittals and Approvals
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
The above equipment and systems integral to them are complete and ready for functional testing. The checklist items are complete and have been checked off only by parties having direct knowledge of the event, respective to each responsible contractor. This Pre-Functional Performance Checklist is submitted for approval, subject to an attached list of outstanding items yet to be completed. A Statement of Correction will be submitted upon completion of any outstanding areas. None of the outstanding items preclude safe and reliable functional tests being performed.
General Contractor Mechanical Contractor
Electrical Contractor TAB Contractor
B-T Supervisor's Office Jackson Ranger Dist DX-2
J14-003A Forest Service Comm Room 213
PFC - DX-2 Duct Free Split DATE:
Temperature Controls Contractor Certified Start-up Technician
Approvals: This filled-out checklist has been reviewed. Its completion is approved with the exceptions noted.
Commissioning Authority Owner's Representative
SI Project #: J14-003A Forest Service 2 of 3 Equipment ID: DX-2
2. Documentation Verification Check each item as verified and initial. Explain deficiencies under Notes.
Y / N Contractor Initial Notes
3. Physical Installation and Inspection Checks Check each item as verified and initial. Explain deficiencies under Notes.
Y / N Contractor Initial Notes
Y / N Contractor Initial Notes
Manufacturer’s cut sheets Performance data (fan curves, coil data, etc.)
Installation and startup manual and plan
· Contractors assigned responsibility for sections of the checklist shall be responsible to see that checklist items by their subcontractors are completed and checked off.
Check
Sequences and control strategies
Pre-functional checklist items are to be completed as part of startup & initial checkout, preparatory to functional testing.
· This checklist is not intended to take the place of the manufacturer’s recommended checkout and startup procedures or report.
· Items that do not apply shall be noted with the reasons on this form (N/A = not applicable, BO = by others).
Operation & Maintenance manuals
Instrumentation installed according to specification
Piping hooked up and properly connected
Vibration isolation equipment installed & released from shipping locks
Check General Installation Permanent labels affixed
Indoor Unit to be mounted level
Piping insulation
Power disconnects in place and labeled All electric connections tight Proper grounding installed for components and unit Safeties in place and operable
Casing condition good: no dents or leaks, door gaskets Maintenance access acceptable for unit and components Clean up of equipment completed per contract documents
Low ambient Control / Crankcase heater installed Dryer installed
All control devices and wiring complete
Wind Baffle Indoor unit condensate connection installed
Electrical and Controls Check
Serial #:_________________ Model #:_________________ Manufacture:______________
Motor Volts - Rated:________ Actual:_________ Motor Amps- Rated:________ Actual:_________
TAB
Installation of system and balancing devices allowed balancing to be completed following specified contract
Final
SI Project #: J14-003A Forest Service 3 of 3 Equipment ID: DX-2
4. Notes Refer to Notes under individual line items.
Note
Startup report completed with this checklist attached Safeties installed and safe operating ranges for this equipment provided to the commissioning agent
END OF CHECKLIST
Project Title : B-T Supervisors Office Jackson Ranger District SI Project No: J14-003A Forest Service 1 of 3 Equipment ID#: EWH-1
PROJECT: EQUIPMENT ID:
PROJECT #: LOCATION:
REPORT ID:
1. Submittals and Approvals
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date Pre-functional checklist items are to be completed as part of startup & initial checkout, preparatory to functional testing.
Temperature Controls Contractor Certified Start-up Technician
The above equipment and systems integral to them are complete and ready for functional testing. The checklist items are complete and have been checked off only by parties having direct knowledge of the event, respective to each responsible contractor. This Pre-Functional Performance Checklist is submitted for approval, subject to an attached list of outstanding items yet to be completed. A Statement of Correction will be submitted upon completion of any outstanding areas. None of the outstanding items preclude safe and reliable functional tests being performed.
General Contractor Mechanical Contractor
Electrical Contractor TAB Contractor
Approvals: This filled-out checklist has been reviewed. Its completion is approved with the exceptions noted.
Commissioning Authority Owner's Representative
B-T Supervisor's Office Jackson Ranger Dist EWH-1
J14-003A Forest Service Stairs 111
PFC - EWH-1 Electric Wall Heaters DATE:
SI Project No: J14-003A Forest Service 2 of 3 Equipment ID#: EWH-1
2. Documentation Verification Check each item as verified and initial. Explain deficiencies under Notes.
Y / N Contractor Initial Notes
3. Physical Installation and Inspection Checks Check each item as verified and initial. Explain deficiencies under Notes.
Y / N Contractor Initial Notes
Casing condition good: no dents or leaks, door gaskets Maintenance access acceptable for unit and components Clean up of equipment completed per contract documents Instrumentation installed according to specification Vibration isolation equipment installed & released from shipping locks
Check General Installation Permanent labels affixed
Sequences and control strategies
· This checklist is not intended to take the place of the manufacturer’s recommended checkout and startup procedures or report.
· Items that do not apply shall be noted with the reasons on this form (N/A = not applicable, BO = by others).
Operation & Maintenance manuals
Manufacturer’s cut sheets Performance data (fan curves, coil data, etc.)
Installation and startup manual and plan
· Contractors assigned responsibility for sections of the checklist shall be responsible to see that checklist items by their subcontractors are completed and checked off.
SI Project No: J14-003A Forest Service 3 of 3 Equipment ID#: EWH-1
Y / N Contractor Initial Notes
4. Notes Refer to Notes under individual line items.
Note
END OF CHECKLIST
Description
TAB
Installation of system and balancing devices allowed balancing to be completed following specified contract
Final Startup report completed with this checklist attached Safeties installed and safe operating ranges for this equipment provided to the commissioning agent
Proper grounding installed for components and unit Safeties in place and operable All control devices and wiring complete
Electrical and Controls Check
Power disconnects in place and labeled All electric connections tight
SI Project No: J14-003A Forest Service 1 of 3 Equipment ID#: EWH-2
PROJECT: EQUIPMENT ID:
PROJECT #: LOCATION:
REPORT ID:
1. Submittals and Approvals
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
B-T Supervisor's Office Jackson Ranger Dist EWH-2
J14-003A Forest Service Stairs 130
PFC - EWH-2 Electric Wall Heaters DATE:
The above equipment and systems integral to them are complete and ready for functional testing. The checklist items are complete and have been checked off only by parties having direct knowledge of the event, respective to each responsible contractor. This Pre-Functional Performance Checklist is submitted for approval, subject to an attached list of outstanding items yet to be completed. A Statement of Correction will be submitted upon completion of any outstanding areas. None of the outstanding items preclude safe and reliable functional tests being performed.
General Contractor Mechanical Contractor
Electrical Contractor TAB Contractor
Temperature Controls Contractor Certified Start-up Technician
Approvals: This filled-out checklist has been reviewed. Its completion is approved with the exceptions noted.
Commissioning Authority Owner's Representative
Pre-functional checklist items are to be completed as part of startup & initial checkout, preparatory to functional testing.
SI Project No: J14-003A Forest Service 2 of 3 Equipment ID#: EWH-2
2. Documentation Verification Check each item as verified and initial. Explain deficiencies under Notes.
Y / N Contractor Initial Notes
3. Physical Installation and Inspection Checks Check each item as verified and initial. Explain deficiencies under Notes.
Y / N Contractor Initial Notes
Manufacturer’s cut sheets Performance data (fan curves, coil data, etc.)
Installation and startup manual and plan
· Contractors assigned responsibility for sections of the checklist shall be responsible to see that checklist items by their subcontractors are completed and checked off.
Check
Sequences and control strategies
· This checklist is not intended to take the place of the manufacturer’s recommended checkout and startup procedures or report.
· Items that do not apply shall be noted with the reasons on this form (N/A = not applicable, BO = by others).
Operation & Maintenance manuals
Check General Installation Permanent labels affixed
Instrumentation installed according to specification Vibration isolation equipment installed & released from shipping locks
Casing condition good: no dents or leaks, door gaskets Maintenance access acceptable for unit and components Clean up of equipment completed per contract documents
SI Project No: J14-003A Forest Service 3 of 3 Equipment ID#: EWH-2
Y / N Contractor Initial Notes
4. Notes Refer to Notes under individual line items.
Note
Power disconnects in place and labeled All electric connections tight Proper grounding installed for components and unit Safeties in place and operable All control devices and wiring complete
Electrical and Controls Check
TAB
Installation of system and balancing devices allowed balancing to be completed following specified contract
Final Startup report completed with this checklist attached Safeties installed and safe operating ranges for this equipment provided to the commissioning agent
END OF CHECKLIST
SI Project No: J14-003A Forest Service 1 of 3 Equipment ID#: EWH-3
PROJECT: EQUIPMENT ID:
PROJECT #: LOCATION:
REPORT ID:
1. Submittals and Approvals
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date Pre-functional checklist items are to be completed as part of startup & initial checkout, preparatory to functional testing.
Temperature Controls Contractor Certified Start-up Technician
Approvals: This filled-out checklist has been reviewed. Its completion is approved with the exceptions noted.
Commissioning Authority Owner's Representative
The above equipment and systems integral to them are complete and ready for functional testing. The checklist items are complete and have been checked off only by parties having direct knowledge of the event, respective to each responsible contractor. This Pre-Functional Performance Checklist is submitted for approval, subject to an attached list of outstanding items yet to be completed. A Statement of Correction will be submitted upon completion of any outstanding areas. None of the outstanding items preclude safe and reliable functional tests being performed.
General Contractor Mechanical Contractor
Electrical Contractor TAB Contractor
B-T Supervisor's Office Jackson Ranger Dist EWH-3
J14-003A Forest Service Stairs 141
PFC - EWH-3 Electric Wall Heaters DATE:
SI Project No: J14-003A Forest Service 2 of 3 Equipment ID#: EWH-3
2. Documentation Verification Check each item as verified and initial. Explain deficiencies under Notes.
Y / N Contractor Initial Notes
3. Physical Installation and Inspection Checks Check each item as verified and initial. Explain deficiencies under Notes.
Y / N Contractor Initial Notes
Casing condition good: no dents or leaks, door gaskets Maintenance access acceptable for unit and components Clean up of equipment completed per contract documents Instrumentation installed according to specification Vibration isolation equipment installed & released from shipping locks
Check General Installation Permanent labels affixed
Sequences and control strategies
· This checklist is not intended to take the place of the manufacturer’s recommended checkout and startup procedures or report.
· Items that do not apply shall be noted with the reasons on this form (N/A = not applicable, BO = by others).
Operation & Maintenance manuals
Manufacturer’s cut sheets Performance data (fan curves, coil data, etc.)
Installation and startup manual and plan
· Contractors assigned responsibility for sections of the checklist shall be responsible to see that checklist items by their subcontractors are completed and checked off.
SI Project No: J14-003A Forest Service 3 of 3 Equipment ID#: EWH-3
Y / N Contractor Initial Notes
4. Notes Refer to Notes under individual line items.
Note
END OF CHECKLIST
Description
TAB
Installation of system and balancing devices allowed balancing to be completed following specified contract
Final Startup report completed with this checklist attached Safeties installed and safe operating ranges for this equipment provided to the commissioning agent
Proper grounding installed for components and unit Safeties in place and operable All control devices and wiring complete
Electrical and Controls Check
Power disconnects in place and labeled All electric connections tight
SI Project No: J14-003A Forest Service 1 of 3 Equipment ID#: EWH-4
PROJECT: EQUIPMENT ID:
PROJECT #: LOCATION:
REPORT ID:
1. Submittals and Approvals
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
B-T Supervisor's Office Jackson Ranger Dist EWH-4
J14-003A Forest Service Chase 239
PFC - EWH-4 Electric Wall Heaters DATE:
The above equipment and systems integral to them are complete and ready for functional testing. The checklist items are complete and have been checked off only by parties having direct knowledge of the event, respective to each responsible contractor. This Pre-Functional Performance Checklist is submitted for approval, subject to an attached list of outstanding items yet to be completed. A Statement of Correction will be submitted upon completion of any outstanding areas. None of the outstanding items preclude safe and reliable functional tests being performed.
General Contractor Mechanical Contractor
Electrical Contractor TAB Contractor
Temperature Controls Contractor Certified Start-up Technician
Approvals: This filled-out checklist has been reviewed. Its completion is approved with the exceptions noted.
Commissioning Authority Owner's Representative
Pre-functional checklist items are to be completed as part of startup & initial checkout, preparatory to functional testing.
SI Project No: J14-003A Forest Service 2 of 3 Equipment ID#: EWH-4
2. Documentation Verification Check each item as verified and initial. Explain deficiencies under Notes.
Y / N Contractor Initial Notes
3. Physical Installation and Inspection Checks Check each item as verified and initial. Explain deficiencies under Notes.
Y / N Contractor Initial Notes
Manufacturer’s cut sheets Performance data (fan curves, coil data, etc.)
Installation and startup manual and plan
· Contractors assigned responsibility for sections of the checklist shall be responsible to see that checklist items by their subcontractors are completed and checked off.
Check
Sequences and control strategies
· This checklist is not intended to take the place of the manufacturer’s recommended checkout and startup procedures or report.
· Items that do not apply shall be noted with the reasons on this form (N/A = not applicable, BO = by others).
Operation & Maintenance manuals
Check General Installation Permanent labels affixed
Instrumentation installed according to specification Vibration isolation equipment installed & released from shipping locks
Casing condition good: no dents or leaks, door gaskets Maintenance access acceptable for unit and components Clean up of equipment completed per contract documents
SI Project No: J14-003A Forest Service 3 of 3 Equipment ID#: EWH-4
Y / N Contractor Initial Notes
4. Notes Refer to Notes under individual line items.
Note
Power disconnects in place and labeled All electric connections tight Proper grounding installed for components and unit Safeties in place and operable All control devices and wiring complete
Electrical and Controls Check
TAB
Installation of system and balancing devices allowed balancing to be completed following specified contract
Final Startup report completed with this checklist attached Safeties installed and safe operating ranges for this equipment provided to the commissioning agent
END OF CHECKLIST
Project #:J14-003A Forest Service 1 of 3 Equipment ID:FCU-
PROJECT: EQUIPMENT ID:
PROJECT #: LOCATION:
REPORT ID:
1. Submittals and Approvals
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
B-T Supervisors Office Jackson Ranger Dist FCU -
J14-003A Forest Service
PFC -FCU-** Fan Coil Unit DATE:
Approvals: This filled-out checklist has been reviewed. Its completion is approved with the exceptions noted.
Commissioning Authority Owner's Representative
The above equipment and systems integral to them are complete and ready for functional testing. The checklist items are complete and have been checked off only by parties having direct knowledge of the event, respective to each responsible contractor. This Pre-Functional Performance Checklist is submitted for approval, subject to an attached list of outstanding items yet to be completed. A Statement of Correction will be submitted upon completion of any outstanding areas. None of the outstanding items preclude safe and reliable functional tests being performed.
General Contractor Mechanical Contractor
Electrical Contractor TAB Contractor
Project #:J14-003A Forest Service 2 of 3 Equipment ID:FCU-
2. Documentation Verification Check each item as verified and initial. Explain deficiencies under Notes.
Y / N Contractor Initial Notes
3. Physical Installation and Inspection Checks Check each item as verified and initial. Explain deficiencies under Notes.
Y / N Contractor Initial Notes
Ducts (preliminary check) Duct joint sealant properly installed No apparent severe duct restrictions Duct connected into roof vent Duct cleaned as per specifications Unit Duct Flex Connections installed properly
Digital Wall Humidistat installed per Manufactures Recommendations
Vibration isolation equipment installed & released from shipping locks
Casing condition good: no dents or leaks, Piping Connections between Fan Coil Units are tight and in Maintenance access acceptable for unit and components Unit installed per manufactures recomendations
Serial #:____________________ Model #:_____________________ Manufacture:_________________
Instrumentation installed according to mnfg. specification
Condensate Lines attached Per Manufactures Specifications
Check General Installation Permanent labels affixed
Operation & Maintenance manuals
Manufacturer’s cut sheets Performance data (fan curves, coil data, etc.)
Installation and startup manual and plan Sequences and control strategies
Pre-functional checklist items are to be completed as part of startup & initial checkout, preparatory to functional testing.
· This checklist is not intended to take the place of the manufacturer’s recommended checkout and startup procedures or report.
· Items that do not apply shall be noted with the reasons on this form (N/A = not applicable, BO = by others).
· Contractors assigned responsibility for sections of the checklist shall be responsible to see that checklist items by their subcontractors are completed and checked off.
Project #:J14-003A Forest Service 3 of 3 Equipment ID:FCU-
Y / N Contractor Initial Notes
4. Notes Refer to Notes under individual line items.
Note
END OF CHECKLIST
Description
TAB
Installation of system and balancing devices allowed balancing to be completed following specified contract
Final Startup report completed with this checklist attached Safeties installed and safe operating ranges for this equipment provided to the commissioning agent
Power disconnects in place and labeled All electric connections tight Proper grounding installed for components and unit Safeties in place and operable All control devices and wiring complete
Electrical and Controls Check
Motor Voltage - Rated:________Actual:________ Motor Amps - Rated:________ Actual:________
Project Title: B-T Supervisors Office Jackson Ranger Dist.
Project #:J14-003A Forest Service 1 of 3 Equipment ID:HR-1
PROJECT: EQUIPMENT ID:
PROJECT #: LOCATION:
REPORT ID:
1. Submittals and Approvals
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
B-T Supervisor's Office Jackson Ranger Dist HR-1
J14-003A Forest Service
PFC-HR-1 Water Source Heat Recovery Unit DATE:
Approvals: This filled-out checklist has been reviewed. Its completion is approved with the exceptions noted.
Commissioning Authority Owner's Representative
The above equipment and systems integral to them are complete and ready for functional testing. The checklist items are complete and have been checked off only by parties having direct knowledge of the event, respective to each responsible contractor. This Pre-Functional Performance Checklist is submitted for approval, subject to an attached list of outstanding items yet to be completed. A Statement of Correction will be submitted upon completion of any outstanding areas. None of the outstanding items preclude safe and reliable functional tests being performed.
General Contractor Mechanical Contractor
Electrical Contractor TAB Contractor
Project #:J14-003A Forest Service 2 of 3 Equipment ID:HR-1
2. Documentation Verification Check each item as verified and initial. Explain deficiencies under Notes.
Y / N Contractor Initial Notes
3. Physical Installation and Inspection Checks Check each item as verified and initial. Explain deficiencies under Notes.
Y / N Contractor Initial Notes
Ducts (preliminary check) Duct joint sealant properly installed No apparent severe duct restrictions Duct connected into roof vent Duct cleaned as per specifications
Unit Duct Flex Connections installed properly
Spare belt present All bearings and bushings greased to mfg. recommendations
Digital Wall Humidistat installed per Manufactures Recommendations
Vibration isolation equipment installed & released from shipping locks
Low Ambient Kit installed per mnfg. Specifications
Casing condition good: no dents or leaks, door gaskets Boots between ducts and unit tight and in good condition Maintenance access acceptable for unit and components Unit installed per manufactures recomendations
Serial #:____________________ Model #:_____________________ Manufacture:_________________
Instrumentation installed according to mnfg. specification
Wind Baffle installed per mnfg. Specifications
Check General Installation Permanent labels affixed
Operation & Maintenance manuals
Manufacturer’s cut sheets Performance data (fan curves, coil data, etc.)
Installation and startup manual and plan Sequences and control strategies
Pre-functional checklist items are to be completed as part of startup & initial checkout, preparatory to functional testing.
· This checklist is not intended to take the place of the manufacturer’s recommended checkout and startup procedures or report.
· Items that do not apply shall be noted with the reasons on this form (N/A = not applicable, BO = by others).
· Contractors assigned responsibility for sections of the checklist shall be responsible to see that checklist items by their subcontractors are completed and checked off.
Project #:J14-003A Forest Service 3 of 3 Equipment ID:HR-1
Y / N Contractor Initial Notes
4. Notes Refer to Notes under individual line items.
Note
END OF CHECKLIST
Description
TAB
Installation of system and balancing devices allowed balancing to be completed following specified contract
Final Startup report completed with this checklist attached Safeties installed and safe operating ranges for this equipment provided to the commissioning agent
Power disconnects in place and labeled All electric connections tight Proper grounding installed for components and unit Safeties in place and operable All control devices and wiring complete
Electrical and Controls Check
Motor Voltage - Rated:________Actual:________
Project #:J14-003A Forest Service 1 of 3 Equipment ID:HR-2
PROJECT: EQUIPMENT ID:
PROJECT #: LOCATION:
REPORT ID:
1. Submittals and Approvals
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
B-T Supervisor's Office Jackson Ranger Dist HR-2
J14-003A Forest Service
PFC-HR-2 Water Source Heat Recovery Unit DATE:
Approvals: This filled-out checklist has been reviewed. Its completion is approved with the exceptions noted.
Commissioning Authority Owner's Representative
The above equipment and systems integral to them are complete and ready for functional testing. The checklist items are complete and have been checked off only by parties having direct knowledge of the event, respective to each responsible contractor. This Pre-Functional Performance Checklist is submitted for approval, subject to an attached list of outstanding items yet to be completed. A Statement of Correction will be submitted upon completion of any outstanding areas. None of the outstanding items preclude safe and reliable functional tests being performed.
General Contractor Mechanical Contractor
Electrical Contractor TAB Contractor
Project #:J14-003A Forest Service 2 of 3 Equipment ID:HR-2
2. Documentation Verification Check each item as verified and initial. Explain deficiencies under Notes.
Y / N Contractor Initial Notes
3. Physical Installation and Inspection Checks Check each item as verified and initial. Explain deficiencies under Notes.
Y / N Contractor Initial Notes
Ducts (preliminary check) Duct joint sealant properly installed No apparent severe duct restrictions Duct connected into roof vent Duct cleaned as per specifications
Unit Duct Flex Connections installed properly
Spare belt present All bearings and bushings greased to mfg. recommendations
Digital Wall Humidistat installed per Manufactures Recommendations
Vibration isolation equipment installed & released from shipping locks
Low Ambient Kit installed per mnfg. Specifications
Casing condition good: no dents or leaks, door gaskets Boots between ducts and unit tight and in good condition Maintenance access acceptable for unit and components Unit installed per manufactures recomendations
Serial #:____________________ Model #:_____________________ Manufacture:_________________
Instrumentation installed according to mnfg. specification
Wind Baffle installed per mnfg. Specifications
Check General Installation Permanent labels affixed
Operation & Maintenance manuals
Manufacturer’s cut sheets Performance data (fan curves, coil data, etc.)
Installation and startup manual and plan Sequences and control strategies
Pre-functional checklist items are to be completed as part of startup & initial checkout, preparatory to functional testing.
· This checklist is not intended to take the place of the manufacturer’s recommended checkout and startup procedures or report.
· Items that do not apply shall be noted with the reasons on this form (N/A = not applicable, BO = by others).
· Contractors assigned responsibility for sections of the checklist shall be responsible to see that checklist items by their subcontractors are completed and checked off.
Project #:J14-003A Forest Service 3 of 3 Equipment ID:HR-2
Y / N Contractor Initial Notes
4. Notes Refer to Notes under individual line items.
Note
END OF CHECKLIST
Description
TAB
Installation of system and balancing devices allowed balancing to be completed following specified contract
Final Startup report completed with this checklist attached Safeties installed and safe operating ranges for this equipment provided to the commissioning agent
Power disconnects in place and labeled All electric connections tight Proper grounding installed for components and unit Safeties in place and operable All control devices and wiring complete
Electrical and Controls Check
Motor Voltage - Rated:________Actual:________
SI Project #: J14-003A Forest Service 1 of 3 Equipment ID: P-1
PROJECT: EQUIPMENT ID:
PROJECT #: LOCATION:
REPORT ID:
1. Submittals and Approvals
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
Signature Signature
Printed Name Printed Name
Company Company
Date Date
B-T Supervisor's Office Jackson Ranger Dist P-1
J14-003A Forest Service Geo-Thermal Loop Mech. Rm.
PFC - P-1- Pump DATE:
Approvals: This filled-out checklist has been reviewed. Its completion is approved with the exceptions noted.
Commissioning Authority Owner's Representative
The above equipment and systems integral to them are complete and ready for functional testing. The checklist items are complete and have been checked off only by parties having direct knowledge of the event, respective to each responsible contractor. This Pre-Functional Performance Checklist is submitted for approval, subject to an attached list of outstanding items yet to be completed. A Statement of Correction will be submitted upon completion of any outstanding areas. None of the outstanding items preclude safe and reliable functional tests being performed.
General Contractor Mechanical Contractor
Electrical Contractor TAB Contractor
SI Project #: J14-003A Forest Service 2 of 3 Equipment ID: P-1
2. Documentation Verification Check each item as verified and initial. Explain deficiencies under Notes.
Y / N Contractor Initial Notes
3. Physical Installation and Inspection Checks Check each item as verified and initial. Explain deficiencies under Notes.
Y / N Contractor Initial Notes
Manufacture:______________ Model Number:_____________
Power disconnects in place and labeled All electric connections tight Proper grounding installed for components and unit
Pump & Plumbing Pump Lubricated Strainers in place and clean Verifiy proper rotation
Field alignment complete Instrumentation installed according to specification (thermometers, pressure gages, etc.)
Safeties in place and operable All control devices and wiring complete
Serial#:___________________
Electrical and Controls
Motor Volts - Rated:_____ Actual:_______ Motor Amps - Rated:_____ Actual:_______
Pipe fittings complete & pipes properly supported Pipes properly insulated All connections tight Shut off valves / Isolation valves in place
GPM:_________
Equipment Installed Per Specifications for given trade
Head ft.:_________ Motor Efficiency:_________
Voltage:_________, Phase:__________
RPM:_________
Check General Installation Permanent labels affixed
Operation & Maintenance manuals
Manufacturer’s cut sheets…
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