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AGENCIES LTD. 

CA3/CM2 PRECOMMISSIONING SIGN OFF FORM

Please take these forms seriously and ensure all information, including pictures, are provided.  ​

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A minimum fee of $1000 will be charged if the Commission Tech is unable to commission the boilers when they arrive on site.  A 2nd PO will be required prior to return. 

 

Additionally, if the Commission date has been set and agreed upon and cancelled within 72 hours of agreed date, a cancellation fee of $450.00 will be applied. P.O. will be required prior to rescheduling/return. 

1. Form must be filled out completely and signed by the mechanical contractor. 

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 2. If commissioning agents find pre-commissioning work to be incomplete, the project commissioning will not proceed. Additional visits to the commission will require a Purchase Order or Payment in full, prior to site arrival.

Please complete all fields.

CA3 Pre-Commissioning Sign Off Form

Is PPE required on site? (Yes/No)
YES
NO
N/A
Is Site Orientation required prior to start-up? (Yes/No)
YES
NO
N/A

Boilers

Number of Boilers
1
2
3
4
5
6
7
8
Boilers Models ( Please check all that apply):
BACNET / ModBus: (Yes/No)
YES
NO
N/A
BMS 0-10V Signal: (Yes/No)
YES
NO
N/A
System purged of Air: (Yes/No)
YES
NO
N/A
Is Combustion free of halogens (solvents & cleaning fluids) and dust (drywall): (Yes/No)
YES
NO
N/A
Are System Pumps operating: (Yes/No)
YES
NO
N/A
Is there a heat dump available to reject heat during commissioning: (Yes/No)
YES
NO
N/A
Gas Train leak test performed & documented: Yes/No
YES
NO
N/A

Controls

LON card(s) installed in Boiler(s):
YES
NO
N/A
LON CAD cable(s) installed:
YES
NO
N/A
Outdoor sensor installed on cascade/lead boiler:
YES
NO
N/A
Common Supply sensor installed on cascade/lead boiler
YES
NO
N/A
DHW Tank Sensor installed on cascade/lead boiler:
YES
NO
N/A

Venting

Is Venting Fully installed:
YES
NO
N/A

Gas

Fuel: (N/G or L/P)
N/G
L/P
If L/P, has fuel conversion been done:
YES
NO
N/A
Gas Line Purged: (Y/N)
YES
NO
N/A

Safety & System Components

Boiler PRV Installed & Tested:
YES
NO
N/A
LWCO Installed:
YES
NO
N/A
No Evidence of Leaks:
YES
NO
N/A
Power connected to each boiler :
YES
NO
N/A
Boiler pump(s) wired to Contact in boiler:
YES
NO
N/A
DHW pump(s) wired to cascade control:
YES
NO
N/A
Pump(s) installed in correct direction of flow:
YES
NO
N/A
Condensate neutralization kit installed:
YES
NO
N/A
Is each boiler condensate connected:
YES
NO
N/A
Is condensate line vented:
YES
NO
N/A
Is condensate line sloped to drain:
YES
NO
N/A

Mixing Valves

Are there any Viessmann controlled mixing valves:
YES
NO
N/A
Are mixing valves wired back to cascade control:
YES
NO
N/A
Has direction been confirmed for operation:
YES
NO
N/A
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