Specifications


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 lled 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