Manufacturer/Model No. ________________________________
Quantity installed ________________________________
Type of system: Glycol Air Cooled Water
(Circle One)
Standard Points:
Actual Return Temperature (Glycol/Water Systems
Only)
Optional Points:
Fans On/Off ___Yes ___No
Actual Supply Temp ___Yes ___No (Glycol/Water
Sys. Only)
Fan Failure ___Yes ___No (Requires Motor
Starters)
PUMPS (Glycol/Water Systems Only)
Quantity installed _______________________________
Standard Points:
Pump failure
Optional Points:
Pump On/Off ___Yes ___No
Pump Controller Status ___Yes ___No (Auto/Manual,
Stand by)
GPM Actual ___Yes ___No
Flow/No Flow ___Yes ___No
COOLING TOWERS/EVAPORATIVE UNITS (Used in
lieu of building chillers)
Quantity Installed _______________________________
Standard Points:
Actual Return Temperature
Optional Points:
Actual Supply Temperature ___Yes ___No
Spray Pump On/Off ___Yes ___No
Pump Alarm ___Yes ___No
Fan On/Off ___Yes ___No
Dampers Open ___Yes ___No
POWER DISTRIBUTION UNITS
Manufacturer/Model No. _______________________________
Quantity installed _______________________________
Input Voltage _______________________________
Standard Points:
Summary Alarm (Check for summary alarm contact,
if not available see option list)
Optional Points:
Actual Voltage Input Total ___Yes ___No (Requires
PT's)
Actual KVA/Amp Input Total ___Yes ___No (Requires
CT's)
Future Units planned ___Yes ___No ___Quantity
FREQUENCY CHANGERS/MOTOR GENERATORS (415
Hz and 60 Hz)
Manufacturer/Model No. _________________________________
Voltage and Frequency _____________Voltage____________Frequency
Quantity installed _____________
Parallel Cabinet ___Yes ___No
Standard Points:
Summary Alarm (Will indicate if unit is in
overvoltage or overtemp)
Optional Points:
Voltage Input ___Yes ___No (Requires PT's)
Voltage Output ___Yes ___No (Requires PT's)
Bearing Overtemp ___Yes ___No
Choke Overtemp ___Yes ___No (Only on Paralleled
Units)
Future Units planned ___Yes ___No ___Quantity
KVA/Amp Current Input ___Yes ___No (Requires
CT's)
KVA/Amp Current Output ___Yes ___No (Requires
CT's)
UNINTERRUPTIBLE POWER SUPPLY (UPS)
Manufactorer/Model No. ______________________________
Quantity Installed ______________________________
Voltage and KVA Rating ______________________________
Remote Indicator Panel ___Yes ___No
Location of UPS ______________________________
Standard Points:
Summary Alarm
Low Battery
Primary Power Input Failure
Optional Points:
UPS on Bypass ___Yes ___No
UPS on Battery ___Yes ___No
UPS Primary Power Loss ___Yes ___No
UPS AC Over/Under Voltage ___Yes ___No
UPS Actual KVA/Amp Output ___Yes ___No (Requires
CT's)
UPS Battery Time remaining ___Yes ___No
Temp/Humid in UPS Room ___Yes ___No
Battery String Current ___Yes ___No___# of
strings___# of batteries/string
Battery Rm Exhaust Fan Status ___Yes ___No
Future Units planned ___Yes ___No ___Quantity
DIESEL GENERATOR
Manufacturer/Model No. ________________________________
Quantity installed ________________________________
KW Rating ________________________________
Year installed ________________________________
Remote Panel in Comp. Rm ___Yes ___No (if
yes, list items)
Location of Diesel ________________________________
Standard Points:
Diesel Running
Optional Points:
Diesel Fail to Start ___Yes ___No
Diesel Overspeed ___Yes ___No
Diesel Overcrank ___Yes ___No
Low Battery ___Yes ___No
Low Fuel (Main Tank) ___Yes ___No (Requires
float)
Day Tank Low Fuel ___Yes ___No (Requires
float)
Low Water Temp ___Yes ___No
High Water Temp ___Yes ___No
Actual Diesel Power Output ___Yes ___No (Requires
CT's)
Day Tank Fuel Pump ___Yes ___No
Temp/Humid in Diesel Room ___Yes ___No
Future Units planned ___Yes ___No ___Quantity
FIRE/HALON/SPRINKLER SYSTEMS
Manufacturer/Model No. ___________________________________
Number of Halon Hazards ________ (These are
the areas that halon is discharged into)
Wet Sprinkler System Ceiling_____________Underfloor______________
Dry Pre-Action System Ceiling_____________Underfloor______________
Existing Connected Reserve Halon ___Yes ___No
Co2 System ___Yes ___No
Standard Points:
First Stage Alarm (One Smoke Detector in
Alarm)
Second Stage Alarm (Two Smoke Detectors in
Alarm)
Halon Discharged
Fire Panel Trouble
Optional Points:
System Aborted ___Yes ___No
Sprinkler Water Flow (Wet) ___Yes ___No
Pre-Action System Filled ___Yes ___No
Pre-Action Low Air ___Yes ___No
Sprinkler Valve Shut-off Closed ___Yes ___No
SMOKE DETECTION Note: This is an optional
item. CHEC would display each detector with exact location.
Manufacturer/Model No. ________________________________
Quantity installed Ceiling__________Underfloor___________
Existing Graphic Annunciator ___Yes ___No
Relay Base ___Yes ___No (A Relay Base is
required to annunciate each smoke detector)
Early Warning Sys. IFD ___Yes ___No
WATER DETECTION
Manufacturer/Model No. _________________________________
Type of Existing System ___Spot Type ___Cable
Type
Number of Zones _________________________________
Total feet(Cable Type) _________________________________
Standard Points:
Summary Alarm (From an Existing Control Panel)
Optional Points:
New Water Detectors ___Spot ___Cable ___Quantity
TEMPERATURE/HUMIDITY MONITORING
NOTE: Computer Manufacturers require monitoring
of space Temp/Humid at equipment.
Standard Points:
Temp/Humid for each area within the computer
room (Approx. 1500 sq. ft. per Sensor)
Optional Points:
Temp/Humid for other areas ___Yes ___No List:________________
Dewpoint Sensor ___Yes ___No
Outdoor Temp/Humid ___Yes ___No (Suggested
for water/glycol)
SECURITY
Door Monitoring ___Yes ___No
Other List:___________________________________
POWER MONITORING
Primary Utility Power Voltage ___Yes ___No
Primary Utility Power Current/Usage ___Yes
___No
SPECIAL SYSTEMS
Battery Gas (hydrogen) ___Yes ___No
Air Quality (Particle Count) ___Yes ___No
Building Alarms ___Yes ___No List:______________
Computer Equipment ___KVA ___Temp/Humid
Communications Equipment ___Yes ___No List:______________
Other List:________________________________
REMOTE CONTROL or INTERFACE OF: Optional
Legent Automate XC Interface ___Yes ___No
SYMON Display Interface ___Yes ___No
Netview or Netman Interface ___Yes ___No
Reset Systems ___Yes ___No List:______________
Automatic Dialer ___Yes ___No
Page via PA System ___Yes ___No
Voice Dialer ___Yes ___No
Remotely Turn Equipment On/Off ___Yes ___No
List:______________
Other List:________________________________
GENERAL QUESTIONS FOR PC BASED SYSTEM
Is customer going to supply PC ___Yes ___No
Need for Remote Monitor/Keyboards ___Yes
___No ___Quantity
(250 ft. Max. from PC) (7 Maximum)
Need for Remote PC's ___Yes ___No ___Quantity
Need for Remote Printers ___Yes ___No ___Quantity
Any Remote Computer Rooms ___Yes ___No ___Quantity
(If yes, where are they located) _________________________________
Do you want a price to connect remote ___Yes
___No
Will PC be located in Computer Room ___Yes
___No
(If not, where) _________________________________
Who will be untimately responsible for monitoring
the alarms on the PC?____________________________________________________________
SERVICE CONTRACTOR INFORMATION
Uninterruptible Power Systems (UPS) Electrical
Contractor
Name:________________________ Name:_______________________
Address:______________________ Address:_____________________
_____________________________ ____________________________
Phone #:______________________ Phone #:_____________________
Contact:_______________________ Contact:______________________
Diesel Generator Systems Security Systems
Name:________________________ Name:_______________________
Address:______________________ Address:_____________________
_____________________________ ____________________________
Phone #:______________________ Phone #:_____________________
Contact:_______________________ Contact:______________________
Fire/Halon/Smoke Detection Systems Air Conditioning
Systems/Mechanical Contr.
Name:________________________ Name:_______________________
Address:______________________ Address:_____________________
_____________________________ ____________________________
Phone #:______________________ Phone #:_____________________
Contact:_______________________ Contact:______________________
Sprinkler Systems Internal Maintenance or
Facilities Manager
Name:________________________ Name:_______________________
Address:______________________ Address:_____________________
_____________________________ ____________________________
Phone #:______________________ Phone #:_____________________