QA Program Quality Installation
Contractor Checklist
1. ADMINISTRATIVE N/A
1.1. Home Address____________________________________________
1.2. City:_____________________
1.3. State:_______
1.4. Zip:__________
1.5. Area Served: Whole house Bonus Room Master Suite Upstairs Downstairs Other: ____________
1.6. Permit number: ___________________________________________
1.7. Authority Having Jurisdiction__________________________________
1.8. Recognition: RSI HVAC QI Certificate? ENERGY STAR Certified Home?
1.9. Certificate Distribution: Certificate to Homeowner?
1.10. Email address: ____________________________________________
1.11. Certificate Distribution: Certificate to Homebuilder?
1.12. Email address: ____________________________________________
Documentation Confirmation Statement: Documents for this installation, as applicable, are available for review: Manual J
1.13. heat loss / gain calculations, OEM expanded performance data, OEM Blower Tables, duct leakage measurements, and
TAB records. (Signature) ______________________________________________________________
2. DESIGN
2.1. Heat Loss/Gain
2.1.1 Conditioned Floor Area Served by Unit: ___________________________________ Sq. Ft. -
2.1.2 Design Total Heat Loss: ___________________________________ Btu/h
2.1.3 Design Sensible Heat Gain: ___________________________________ Btu/h
2.1.4 Design Latent Heat Gain: ___________________________________ Btu/h
2.1.5 Design Total Heat Gain: ___________________________________ Btu/h
2.2. System Configuration
2.2.1 Installed Equipment is: Forced Air Split System Package Unit Ductless Geothermal Hydronic
2.2.2 Split system: Condenser and Coil Condenser and Fan Coil Unit
2.2.3 Ductless: One indoor unit Two indoor units Three or more indoor units
2.3. Heating Equipment (If applicable)
2.3.1 Primary Heat Source: Furnace Heat Pump (w/ Coil or Fan Coil Unit) Electric Furnace Boiler
2.3.2 Brand: ____________________________________
2.3.3 Model: ____________________________________
2.3.4 Serial: ____________________________________
2.3.5 Output Capacity (Furnace: highest stage, Heat Pump – at design ODT): ___________________________________ Btu/h
2.3.6 AHRI Reference Number: ____________________________________
2.3.7 Heating Efficiency: Furnace _________________ AFUE Heat Pump _____________ HSPF
2.3.8 Burner Stages: Single Stage Two Stage Multi-Stage
2.3.9 Fuel: Natural Gas Liquid Petroleum (LP) Oil
2.3.10 Blower Motor: Permanent Split Capacitor (PSC) Variable Speed
2.3.11 Venting Type: Sealed Combustion Atmospherically Vented One-Pipe (fan powered exhaust)
2.3.12 Secondary Heat Source: Furnace Supplemental Electric Resistance Heat
2.3.13 Brand: ___________________________________
2.3.14 Model: ___________________________________
2.3.15 Serial: ___________________________________
2.3.16 Output Capacity (highest stage): ________________________________ Kw / Btu/h
2.3.17 AHRI Reference Number:
2.3.18 Burner Stages: Single Stage Two Stage Multi-Stage
2.3.19 Fuel: Natural Gas Liquid Petroleum (LP) Oil
2.3.20 Blower Motor: Permanent Split Capacitor (PSC) Variable Speed (ECM,
2.3.21 Venting Type: Sealed Combustion Atmospherically Vented One-Pipe (fan powered exhaust)
2.3.22 Output of Replaced Unit:
2.3.23 Selected heating equipment meets Manual S sizing tolerance: Pass Fail
2.4. Cooling Equipment (If applicable)
2.4.1 Cooling System: Air Conditioner Heat Pump
2.4.2 AHRI Reference Number: ________________________________________
2.4.3 Cooling Efficiency: _____________________________ SEER _________________________________ EER
2.4.4 Nominal Capacity: ______________________________________ Tons
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2.4.5 OEM Expanded Capacity (with matched indoor unit / at design airflow): ___________________________________ Btu/h
2.4.6 Cooling Stages: Single Stage Two Stage Variable Speed
2.4.7 Brand: ______________________________________
2.4.8 Model: ______________________________________
2.4.9 Serial: ______________________________________
2.4.10 Brand: Evaporator Coil Fan Coil Unit
2.4.11 Brand: ______________________________________
2.4.12 Model: ______________________________________
2.4.13 Serial: ______________________________________
2.4.14 Blower Motor: Permanent Split Capacitor (PSC) Variable Speed
2.4.15 Metering Device: TXV TEV Fixed bore (piston)
2.4.16 Nominal Tonnage of Replaced Unit: ____________________
2.4.17 Selected cooling equipment meets Manual S sizing tolerance: Pass Fail
2.5. Accessories (If applicable)
2.5.1 Accessory: Pump (Hydronics/Geothermal)
2.5.2 Brand: ______________________________________
2.5.3 Model: ______________________________________
2.5.4 Serial: ______________________________________
2.5.5 Capacity: ______________________________________ GPH
2.5.6 Accessory: Filter Humidifier De-humidifier UV light Other: _______________________________
2.5.7 Brand: ______________________________________
2.5.8 Model: ______________________________________
2.5.9 Accessory: Filter Humidifier De-humidifier UV light Other: _______________________________
2.5.10 Brand: ______________________________________
2.5.11 Model: ______________________________________
2.5.12 Accessory: Filter Humidifier De-humidifier UV light Other: _______________________________
2.5.13 Brand: ______________________________________
2.5.14 Model: ______________________________________
2.5.15 Accessory: Filter Humidifier De-humidifier UV light Other: _______________________________
2.5.16 Brand: ______________________________________
2.5.17 Model: ______________________________________
2.5.18 Accessory: Filter Humidifier De-humidifier UV light Other: _______________________________
2.5.19 Brand: ______________________________________
2.5.20 Model: ______________________________________
2.6. Airflow (If applicable)
2.6.1 Duct distribution system will be modified: Yes No
2.6.2 Design ESP: ______________________________________ ESP
2.6.3 Design Airflow: ______________________________________ Cfm
2.6.4 Design Fan Speed (Heating): _______________________________________
2.6.5 Design Fan Speed (Cooling): ______________________________________
2.6.6 Design Variable Speed Fan Setting(s) (Speed tap or dip switch settings): ___________________________________
2.7. On Rate Combustion
2.7.1 Venting is in compliance with: NFPA 54 NFPA 31 (oil) IFGC Authority Having Jurisdiction (AHJ)
2.7.2 If venting is per AHJ, provide name of jurisdiction: _______________________________________
2.7.3 System Has Dedicated Combustion Air From Outside Yes No
2.8. Controls
Type of thermostat selected: Two stage heat / Single stage cool Single stage heat / Single stage cool
2.8.1
Single stage heat / Two stage cool Multi-stage heat / multi-stage cool
3. INSTALLATION
3.1. Airflow
3.1.1 Airflow tested in which mode? Heating Cooling
3.1.2 Fan Speed: Hi Med- Hi Med Med-Lo Lo Variable Speed
3.1.3 Return / Entering Air Static Pressure: _______________________________________ IWC
Return / Entering Air test port location: Return air plenum (pre-filter) Equipment cabinet (post-filter)
3.1.4
Return air (filter) grille Before the coil (furnace–coil transition)
3.1.5 Supply / Leaving Static Pressure: ________________________________________ IWC
Supply / Leaving Air test port location: Furnace limit switch sensor port Supply air plenum
3.1.6
After the furnace (furnace – coil transition)
3.1.7 External Static Pressure (or pressure difference): _______________________________________ IWC
3.1.8 Airflow (based on ESP): _______________________________________ CFM
3.1.9 OEM Maximum Allowable Total External Static Pressure: ________________________________________ IWC
3.1.10 Return and Supply Test Hole Locations marked and sealed. Yes No
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3.2. Refrigerant Charge – Run system for 10 minutes before testing DO NOT TEST BELOW 60°F
3.2.1 Sub-Cooling: Test Thermal Expansion Valve (TXV) Systems only
3.2.1.a Liquid Line Temperature _______________________________________ °F DB
3.2.1.b Liquid Line Pressure: ________________________________________ psig
3.2.1.c Liquid Line Temperature for Pressure 3.2.1.b: _______________________________________ °F DB
3.2.1.d Measured sub-cooling (3.2.1.b – 3.2.1.c): _______________________________________ °F DB
3.2.1.e OEM sub-cooling target: _______________________________________ °F DB
3.2.1.f Sub-cooling deviation (3.2.1.e – 3.2.1.d): _______________________________________ °F DB
3.2.2 Super-Heat Test: Fixed Orifice, Cap Tube, Piston Metering Systems only:
3.2.2.a DB Temperature (at condenser): _______________________________________ °F DB
3.2.2.b WB Temperature (at Air Handler return): ______________________________________ °F WB
3.2.2.c Suction Line (SL) Temperature (at condenser): _______________________________________ °F DB
3.2.2.d Suction Line pressure (at condenser): ________________________________________ psig
3.2.2.e Suction Line Temperature for Pressure 3.2.2.d: _______________________________________ °F DB
3.2.2.f Measured super-heat (3.2.2.c – 3.2.2.e): _______________________________________ °F DB
3.2.2.g OEM super-heat target: _______________________________________ °F DB
3.2.2.h Super-heat deviation:(3.2.2.g – 3.2.2.h): _______________________________________ °F DB
3.2.2.i Value 3.2.1.f is ≥ 3°F OR Value 3.2.2.h is ≥ 5°F Pass Fail
If OEM test procedure has been used: documentation has been filed that defines this procedure, documents the refrigerant
3.2.2.j
measurements not recorded above, and all is available upon request. Pass Fail
3.3. Electrical Measurements
3.3.1 Indoor fan motor: _____________ amperage ___________line voltage
3.3.2 Inducer fan motor: _____________ amperage ___________line voltage
3.3.3 Condenser / Heat pump: _____________ amperage ___________line voltage
3.3.4 Outdoor fan motor: _____________ amperage ___________line voltage
3.3.5 Electrical measurements within OEM-specified tolerance of nameplate value Pass Fail
3.4. On Rate Combustion (When Fossil Fuel Equipment Is Installed)
Combustion Appliance Startup Testing (All Appliances): Altitude De-rating Factor: ________________
3.4.1
Nameplate Temp. Rise Range: _______________ °F DB; Measured Temp. Rise: ________________ °F DB
3.4.2 For Gas Appliances: Manifold Pressure: _______ IWC (gas) Orifice Size:________
For Oil Appliances: Oil Nozzle Size and Spray Angle: ___________ ; Oil type: __________________ ;
3.4.3
________________ Pump Pressure: _____________________ psig; Pump Flow: _________________ GPH
Combustion Analyzer: CO (air free): _________PPM Stack Temperature: ___________ °F Efficiency: __________ %
3.4.4
Outdoor Temp: ____ °F Draft Pressure: ________Pa Explanation why combustion tests not performed: ____________
3.5. Combustion Venting (When Fossil Fuel Equipment Is Installed)
3.5.1 Vent piping is properly sloped and supported? Pass Fail
3.5.2 Vent piping is free of rust, oxidation, or soot? Pass Fail
3.5.3 Vent piping is free of obstruction (not blocked)? Pass Fail
3.5.4 After 5 minutes of operation (or as specified by the manufacturer), vent is drafting (no spillage or back drafting). Pass Fail
3.5.5 New installation has left an orphaned combustion appliance (water heater, furnace, or boiler). Pass Fail
3.5.6 The orphaned appliance’s vent system meets the code requirement. Yes No
3.5.7 If no, provide explanation. ______________________________________________________________________
3.5.8 Fuel line leakage testing performed Pass Fail
4. DISTRIBUTION ASPECTS
4.1. Duct Leakage Testing
4.1.1 Duct Leakage Goal (New Home - Under Construction): ≤ 10% Total ≤ 6% Total Per AHJ
4.1.2 Duct Leakage Goal (Existing Home): ≤ 20% Total 50% Improvement (Item 4.1.5 required) Per AHJ
4.1.3 Duct Leakage Test Procedure: Duct Blaster (CFM25) Airflow Comparison SMACNA Air Leakage Per AHJ
4.1.4 Recorded (or confirmed accuracy of) airflow measurements in Section 3.1 after duct sealing was performed? Yes No
4.1.5 Total Duct Leakage Pre-Installation: ___________________________________ CFM25/CFM
4.1.6 Total Duct Leakage Post-Installation: ___________________________________ CFM25/CFM
4.1.7 Improvement (4.1.5 less 4.1.6, divided by 4.1.6): ______________________________ % Pass Fail
4.2. Test and Balance
4.2.1 Total Measured Supply Air (from all supply outlets): Cfm
4.2.2 Total Measured Return Air (from all return inlets): Cfm
Designer Name: _______________________________________ Design Date: ___________________________________________
Technician Name: _____________________________________ Start-up Date: __________________________________________
HVAC Contractor ID#: _________________________________ Date Submitted: _________________________________________
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