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GENERAL

FIRST NAME

LAST NAME

ADDRESS

EMAIL

PHONE

HEAVENLY HOME PLAN MEMBER?

Yes

No

DATE AND TIME

Month

Day

Year

Time

:HoursMinutes

REFRIGERANT

R-22

R-410A

R-32

R-454B

EQUIPMENT TYPE

Standard

Mini-Split

CONDENSER MODEL NUMBER

CONDENSER SERIAL NUMBER

AGE OF CONDENSER

EVAPORATOR MODEL NUMBER

EVAPORATOR SERIAL NUMBER

AGE OF EVAPORATOR

FURNACE MODEL NUMBER

FURNACE SERIAL NUMBER

AGE OF FURNACE

HVAC DECODER

TURN THERMOSTAT TO COOL & TEST OPERATION

Yes

No

CHECK THERMOSTAT BATTERIES

Yes

No

CARBON MONOXIDE DETECTORS?

Yes

No

INSIDE

AIR FILTER

AIR FILTER SIZE

FILTER CONDITION

Functional

Replace Soon

Replace

REFRIGERANT PRESSURES

METERING DEVICE

TXV

Fixed Orifice

INDICATOR

Subcool

Superheat

METERING DEVICE

TARGET

ACTUAL

TXV SENSING BULB PROPERLY INSTALLED?

TXV SENSING BULB INSULATION

TXV SENSING BULB FUNCTIONAL?

Yes

No

TEMPERATURE DROP (RATED 17-21 DEGREES)

TEMPERATURE DROP

STATIC PRESSURE (RETURN)

STATIC PRESSURE (SUPPLY)

STATIC PRESSURE DIFFERENTIAL (DESIRED BELOW 0.50" WC)

FAN SPEEDS

FAN SPEEDS GOOD?

Yes

No

DRAIN HOSES

DRAIN HOSES GOOD?

Yes

No

BLOWER MOTOR AMP DRAW (RATING)

BLOWER MOTOR AMP DRAW (MEASURED)

WATER LEAK ALARM?

Yes

No

HEAT EXCHANGERS

HEAT EXCHANGER OBSERVATIONS

Rust

Holes

Corrosion

Heat Stress

Fracture(s)

Bad Rivet(s)

Dirt

Dust

Debris

Plugged

POTENTIAL FOR CARBON MONOXIDE LEAK?

Yes

No

INDUCER MOTOR GASKET

GASKET LEAKING WATER IN FURNACE?

Yes

No

COLLECTOR BOX GASKET

GASKET LEAKING WATER IN FURNACE?

Yes

No

BLOWER MOTOR

BLOWER MOTOR CAPACITOR

BLOWER MOTOR CAPACITOR (RATING)

BLOWER MOTOR CAPACITOR (MEASURED)

CAPACITOR OUT OF TOLERANCE?

Yes

No

EVAPORATOR COIL

EVAPORATOR COIL OBSERVATIONS

Dust

Dirt

Debris

Rust

Corrosion

Signs of Leak

DRAIN PAN

EVAPORATOR COIL OBSERVATIONS

Dust

Dirt

Debris

Rust

Corrosion

Signs of Leak

DOES DRAIN PAN HAVE WATER TREATMENT PAD?

Yes

No

DID TECHNICIAN FLUSH CONDENSATE TRAP, FITTINGS, AND DRAIN LINES?

Yes

No

DUCT WORK

DUCT WORK OBSERVATIONS

Dust

Dirt

Debris

Rust

Corrosion

Signs of Leak

RELATIVE HUMIDITY

HUMIDITY OBSERVATIONS

Dry

Humid

ELECTRICAL WIRING

CIRCUIT BOARD

Is unit equipped with a whole-house humidifier?

Is unit equipped with a whole-house DEhumidifier?

Is unit equipped with an ultraviolet virus & bacteria eliminating light?

Is unit equipped with an electronic air filter?

Is unit equipped with a hospital-grade HEPA filter?

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