This form must be submitted within 21 days of startup to activate the 1 Year Service Plan

Which of the following Water Heaters is installed? *

Start-Up Performed By

Company *

Technician's Name *

Country Code

Phone Number

Installation Details

Report Type *

Original Startup
Service Call

Serial Number *

Date Field *

Installation Job Name (Include Store Number if Applicable) *

Installation Address *

Address line 2

City *

State/Province *

Zip/Postal Code *

Country

Installation Type *

New
Replacement

Building Application Type *

School
Lodging
Hospital
Restaurant
Other

Pre Start-Up Checklist

Inspect the unit for the following points as applicable and refer to the product Installation and Maintenance Manual prior to Start‐Up. Note any deficiencies in the space provided at the end of the report.

General

Is the electrical disconnect set to the OFF Position? *

Yes
No
N/A

Is the unit damaged or are there an missing parts? *

Yes
No
N/A

Is there adequate clearance for proper operation and maintenance? *

Yes
No
N/A

Has the venting been properly connected and complete? *

Yes
No
N/A

Are all piping connections complete tight leak free and damage free? *

Yes
No
N/A

Are all tank connections/fittings non-ferrous metal or stainless steel? (No galvanized fittings or dielectric unions) *

Yes
No

Take photo showing the overall length of the water heater

Are there any deficiencies to note related to the mechanical room or general plumbing system? (e.g. roof leak drywall damage fixture repair) If yes please explain.

Water System

Temperature and Pressure relief valve(s) piped to a suitable floor drain? *

Yes
No
N/A

Expansion tank installed in the cold water supply? *

Yes
No
N/A

Water softener on the cold water supply? *

Yes
No
N/A

Mixing valve on the hot water supply? *

Yes
No
N/A

Is the condensate trap installed and positioned properly? *

Yes
No
N/A

Is there a building recirculation loop piped to the water heater? *

Yes
No
N/A

Is the building return line connected to the dedicated building return fitting on the water heater as required by PVI? *

Yes
No
N/A

Are ball valves installed on inlet and outlets of water heater?

Yes
No
N/A

What is the pressure charge in PSI on the expansion tank?

Take photo of thermometers on the cold and hot water lines of the heater *

Take photo of condensate trap

Take photo of T and P valve

Take photo of floor drain with condensate and T and P valve piped to it

Building Management / Automation Systems (skip and hit next if not applicable)

Gateway installed?

Yes
No
N/A

EMS Discrete Interface?

Enable
Disable
Remote On-Off
N/A

EMS Communication Interface?

Modbus
Bacnet
Other
N/A

EMS connected to which field access terminals:

Field Wire Gauge:

EMS Brand (JCI Siemens etc.):

Electrical and Control Requirements

Does the main power supply comply with the unit’s nameplate specifications? *

Yes
No
N/A

Is the unit properly wired to an electrical disconnect or breaker? *

Yes
No
N/A

Are terminal screws and wires connected and secure? *

Yes
No
N/A

Is voltage from Terminal L2 (Neutral) to the Ground Lug on the tank zero (0)? *

Yes
No
N/A

Name Plate Voltage V: / Ø: / Hz: *

Measured Voltage (unit off) V: / Ø: / Hz: *

Measured Voltage (unit on) V: / Ø: / Hz: *

Gas Supply

Type of Gas *

Natural Gas
LP Gas

Gas Pipe Size: *

Gas Pipe Material: *

Is there an intermediate lockup type gas regulator on the inlet gas supply? *

Yes
No
N/A

Is this gas regulator externally vented? *

Yes
No
N/A

Is a drip leg installed on unit? *

Yes
No
N/A

Distance from gas regulator to heater (ft.):

Static Inlet Gas Pressure (in. WC): *

Flow Inlet Gas Pressure (in. WC): *

Combustion and Ventilation Air

Select venting termination type: *

Vertical Direct Vent (two pipe vertical termination)
Horizontal Direct Vent (two pipe sidewall termination)
Vertical Vent with Sidewall Air (single pipe vertical termination with single pipe combustion air supply)
Vertical Vent with Room Air (single pipe vertical termination)
Horizontal Vent with Room Air (single pipe sidewall termination)
Concentric Vent Vertical (single pipe vertical termination)
Concentric Vent Horizontal (single pipe sidewall termination)

Take photo of vent from heater to outside termination

Air Inlet or Combustion Air

Air Inlet Duct Dia. (in.): *

Air Inlet Duct Material: *

Total Eqv. Length (ft.): *

Is there a powered combustion air device damper or louver system? *

Yes
No
N/A

The powered combustion air device is connected to which heater terminals?

Is direct‐duct combustion air combined with other units? *

Common duct size:

Common duct length:

Number of combined units:

Exhaust Vent or Flue Vent

Flue Vent Dia. (in.): *

Flue Vent Material: *

Total Eqv. Length (ft.): *

Is there a powered draft device in the flue system? *

The powered draft device is connected to which heater terminals?

Is the flue vent combined with other units? *

Yes
No
N/A

Common vent size:

Common vent length:

Number of combined units:

Does venting termination meet proper clearances from windows doors and fresh air? *

Yes
No

Take photo of intake vents on roof and/or side of building

Take photo of exhuast vents on roof and/or side of building

Combustion Adjustments

Operating Temperature Set Point: *

Starting Modulation Rate (%): *

Modulation Rate (%) - Low Fire *

Modulation Rate (%) - High Fire *

Carbon Dioxide CO2 (8.0 -9.5% NAT / 9.0-10.5 LP) - Low Fire *

Carbon Dioxide CO2 (8.0 -9.5% NAT / 9.0-10.5 LP) - High Fire *

Oxygen O2 (4.0% - 6.5% NAT / 2% - 4.5% LP) - Low Fire *

Oxygen O2 (4.0% - 6.5% NAT / 2% - 4.5% LP) - High Fire *

Carbon Monoxide CO (should not exceed 200 PPM) - Low Fire *

Carbon Monoxide CO (should not exceed 200 PPM) - High Fire *

Nitrogen Oxide NOx (%) - Low Fire *

Nitrogen Oxide NOx (%) - High Fire *

Vent Pressure - Individual Venting (Maximum 0.3 in. WC) - Low Fire *

Vent Pressure - Individual Venting (Maximum 0.3 in. WC) - High Fire *

Vent Pressure - Common Venting (must be assisted venting maximum negative 0.25 in. WC) - Low Fire

Vent Pressure - Common Venting (must be assisted venting maximum negative 0.25 in. WC) - High Fire

Net Vent Temperature (Degrees Fahrenheit) - Gross vent temp minus ambient air temp - Low Fire *

Net Vent Temperature (Degrees Fahrenheit) - Gross vent temp minus ambient air temp - High Fire *

Sign Off

Technician's Name (First and Last)

I (Technicians Name Above) certify all the information submitted to be accurate and true.

Additional Comments

Upload any additonal pictures here

Upload any additional pictures here