ELECTRICAL & A/C MAINTENANCE DIVISION - MAA
HVAC SURVEY & TECHNICAL REPORT REQUEST FORM.
To: Area HVAC Contract Engineer. Request Date:
Complaint Reference Memo/ Work Order No: Dated:
Subject:
Location:
Instructions: You are requested to conduct a site survey to the above mentioned location and collect all necessary
information and action to be taken to rectify complaints.
KNPC HVAC Engineer -MAA
CC: TL E&A/C M - MAA
Date:
The following to be filled by Contractor.
The above location(s) has been visited on Date:_______________________the following information and data's
were collected.
Equipment Status Temperature Observation
Location Equipment Detail ( Working / Not Working)
Running Unit Stand by Unit Temp. Time Date.
Tag No
Make
Model
Type
Ref.Gas
Trouble shooting Analysis & Action Taken:
Unit Repaired /OH Working Unit Beyond repair, Require Additional Units Required.
Recommendations: Satisfactorily. Replacement.
√√
Reasons:
Contractor HVAC Supervisor: Contractor Engineer:
The following to be filled by Contractor.
The above location(s) has been visited on Date:_______________________the following information and data's
were collected.
Equipment Status Temperature Observation
Location Equipment Detail ( Working / Not Working)
Running Unit Stand by Unit Temp. Time Date.
Tag No
Make
Model
Type
Ref.Gas
Trouble shooting Analysis & Action Taken:
Unit Repaired /OH Working Unit Beyond repair, Require Additional Units Required.
Recommendations: Satisfactorily. Replacement.
√√
Reasons:
Contractor HVAC Supervisor: Contractor Engineer:
The following to be filled by Contractor.
The above location(s) has been visited on Date:_______________________the following information and data's
were collected.
Equipment Status Temperature Observation
Location Equipment Detail ( Working / Not Working)
Running Unit Stand by Unit Temp. Time Date.
Tag No
Make
Model
Type
Ref.Gas
Trouble shooting Analysis & Action Taken:
Unit Repaired /OH Working Unit Beyond repair, Require Additional Units Required.
Recommendations: Satisfactorily. Replacement.
√√
Reasons:
Contractor HVAC Supervisor: Contractor Engineer:
The following to be filled by Contractor.
The above location(s) has been visited on Date:_______________________the following information and data's
were collected.
Equipment Status Temperature Observation
Location Equipment Detail ( Working / Not Working)
Running Unit Stand by Unit Temp. Time Date.
Tag No
Make
Model
Type
Ref.Gas
Trouble shooting Analysis & Action Taken:
Unit Repaired /OH Working Unit Beyond repair, Require Additional Units Required.
Recommendations: Satisfactorily. Replacement.
√√
Reasons:
Contractor HVAC Supervisor: Contractor Engineer:
The following to be filled by Contractor.
The above location(s) has been visited on Date:_______________________the following information and data's
were collected.
Equipment Status Temperature Observation
Location Equipment Detail ( Working / Not Working)
Running Unit Stand by Unit Temp. Time Date.
Tag No
Make
Model
Type
Ref.Gas
Trouble shooting Analysis & Action Taken:
Unit Repaired /OH Working Unit Beyond repair, Require Additional Units Required.
Recommendations: Satisfactorily. Replacement.
√√
Reasons:
Contractor HVAC Supervisor: Contractor Engineer:
The following to be filled by Contractor.
The above location(s) has been visited on Date:_______________________the following information and data's
were collected.
Equipment Status Temperature Observation
Location Equipment Detail ( Working / Not Working)
Running Unit Stand by Unit Temp. Time Date.
Tag No
Make
Model
Type
Ref.Gas
Trouble shooting Analysis & Action Taken:
Unit Repaired /OH Working Unit Beyond repair, Require Additional Units Required.
Recommendations: Satisfactorily. Replacement.
√√
Reasons:
Contractor HVAC Supervisor: Contractor Engineer:
The following to be filled by Contractor.
The above location(s) has been visited on Date:_______________________the following information and data's
were collected.
Equipment Status Temperature Observation
Location Equipment Detail ( Working / Not Working)
Running Unit Stand by Unit Temp. Time Date.
Tag No
Make
Model
Type
Ref.Gas
Trouble shooting Analysis & Action Taken:
Unit Repaired /OH Working Unit Beyond repair, Require Additional Units Required.
Recommendations: Satisfactorily. Replacement.
√√
Reasons:
Contractor HVAC Supervisor: Contractor Engineer:
The following to be filled by Contractor.
The above location(s) has been visited on Date:_______________________the following information and data's
were collected.
Equipment Status Temperature Observation
Location Equipment Detail ( Working / Not Working)
Running Unit Stand by Unit Temp. Time Date.
Tag No
Make
Model
Type
Ref.Gas
Trouble shooting Analysis & Action Taken:
Unit Repaired /OH Working Unit Beyond repair, Require Additional Units Required.
Recommendations: Satisfactorily. Replacement.
√√
Reasons:
Contractor HVAC Supervisor: Contractor Engineer:
The following to be filled by Contractor.
The above location(s) has been visited on Date:_______________________the following information and data's
were collected.
Equipment Status Temperature Observation
Location Equipment Detail ( Working / Not Working)
Running Unit Stand by Unit Temp. Time Date.
Tag No
Make
Model
Type
Ref.Gas
Trouble shooting Analysis & Action Taken:
Unit Repaired /OH Working Unit Beyond repair, Require Additional Units Required.
Recommendations: Satisfactorily. Replacement.
√√
Reasons:
Contractor HVAC Supervisor: Contractor Engineer:
The following to be filled by Contractor.
The above location(s) has been visited on Date:_______________________the following information and data's
were collected.
Equipment Status Temperature Observation
Location Equipment Detail ( Working / Not Working)
Running Unit Stand by Unit Temp. Time Date.
Tag No
Make
Model
Type
Ref.Gas
Trouble shooting Analysis & Action Taken:
Unit Repaired /OH Working Unit Beyond repair, Require Additional Units Required.
Recommendations: Satisfactorily. Replacement.
√√
Reasons:
Contractor HVAC Supervisor: Contractor Engineer:
The following to be filled by Contractor.
