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HVAC (Preventive Maintenance)
Request For Proposal Form
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JOB DESCRIPTION
CHILLERS
Included:
Yes
No
# of Chillers:
Manufacturer and Size of Each Chiller:
Frequency of Operational Check/Inspection:
Daily
Weekly
Monthly
Quarterly
Semi-Annually
Annually
As Needed
Other
BUILDING (ENERGY) MANAGEMENT SYSTEM (BMS/EMS)
Included:
Yes
No
Task(s) to be Accomplished:
Hold down the
CTRL
key on your keyboard while selecting to select more than one option.
Component Replacement Guarantee
Manufacturers Recommended Preventive Maintenance
On-Call Service
Off-Site System Monitoring
Off-Site System Software Backup
Software Upgrades
System Operational Check
Other:
Manufacturer of BMS/EMS:
Frequency of Operational Check/Inspection:
Daily
Weekly
Monthly
Quarterly
Semi-Annually
Annually
As Needed
Other
SUPPLY FAN(S) AND RETURN FAN(S)
Included:
Yes
No
Task(s) to be Accomplished:
Hold down the
CTRL
key on your keyboard while selecting to select more than one option.
Balance Fans
Check Amperage and Voltage of Motors
Check Belt Tightness and Alignment
Check Fan Bearing Operating Temperature
Check Supply Air Temperature
Check/Tighten All Setscrews
Clean Fan Blades and Coils
Complete Vibration Analysis and Excessive Noise Inspection
Inspect Fan Blades and Vanes for Damage
Lubricate Fan Bearings
Other:
# of Devices:
Manufacturer and Size of Each Fan:
Frequency of Inspection:
Daily
Weekly
Monthly
Quarterly
Semi-Annually
Annually
As Needed
Other
EXHAUST FANS
Included:
Yes
No
Task(s) to be Accomplished:
Hold down the
CTRL
key on your keyboard while selecting to select more than one option.
Balance Fans
Clean Fan Blades and Coils
Check Amperage and Voltage of Motors
Check Belt Tightness and Alignment
Check Fan Bearing Operating Temperature
Check/Tighten All Setscrews
Complete Vibration Analysis and Excessive Noise Inspection
Inspect Fan Blades and Vanes for Damage
Lubricate Fan Bearings
Lubricate Motor
Other:
# of Devices:
Manufacturer and Size of Each Fan:
Frequency of Inspection:
Daily
Weekly
Monthly
Quarterly
Semi-Annually
Annually
As Needed
Other
FAN POWERED BOXES AND DUCT SYSTEM
Included:
Yes
No
Task(s) to be Accomplished:
Hold down the
CTRL
key on your keyboard while selecting to select more than one option.
Change Filters
Check Amperage and Voltage of Motors
Check Electric Duct Heaters
Check Motor Operation
Check Supply Air Temperature
Check/Tighten all Setscrews
Lubricate Motor(s)
Other:
Average # of Boxes per Floor:
Manufacturer of Each Fan Box:
Frequency of Inspection:
Daily
Weekly
Monthly
Quarterly
Semi-Annually
Annually
As Needed
Other
FAN COIL UNITS AND CONVERTERS
Included:
Yes
No
Task(s) to be Accomplished:
Hold down the
CTRL
key on your keyboard while selecting to select more than one option.
Change Filters
Check Amperage and Voltage of Motors
Check Electric Duct Heaters
Check Motor Operation
Check Supply Air Temperature
Check/Tighten all Setscrews
Lubricate Motor(s)
Other:
Average # of Units per Floor:
Manufacturer of Each Unit:
Frequency of Inspection:
Daily
Weekly
Monthly
Quarterly
Semi-Annually
Annually
As Needed
Other
PUMPS AND PIPING SYSTEM
Included:
Yes
No
Task(s) to be Accomplished:
Hold down the
CTRL
key on your keyboard while selecting to select more than one option.
Check Amperage and Voltage of Motors
Check Motor Operation
Inspect Piping System
Lubricate Motor(s)
Other:
# of Pipes in Building:
Manufacturer of Each Unit by Size:
Frequency of Inspection:
Daily
Weekly
Monthly
Quarterly
Semi-Annually
Annually
As Needed
Other
COOLING TOWERS
Included:
Yes
No
Task(s) to be Accomplished:
Hold down the
CTRL
key on your keyboard while selecting to select more than one option.
Check Amperage and Voltage of Motors
Check Fan Motor(s) Operation
Inspect for Water Leaks
Lubricate Fan Motor(s)
Manufacturer's Recommended Preventive Maintenance
Visual Inspection of Cooling Tower
Other:
# of Cooling Towers per Building:
# of Cells in each Cooling Tower:
Manufacturer of Each Cooling Tower By Size:
Frequency of Inspection:
Daily
Weekly
Monthly
Quarterly
Semi-Annually
Annually
As Needed
Other
BOILERS
Included:
Yes
No
Task(s) to be Accomplished:
Hold down the
CTRL
key on your keyboard while selecting to select more than one option.
Check Amperage and Voltage of Motors
Complete Code or State Boiler(s) Inspection
Check Pump Motor(s) Operation
Inspect for Water Leaks
Lubricate Pump Motor(s)
Manufacturer's Recommended Preventive Maintenance
Visual Inspection of Boilers
Other:
# of Boilers in the Building:
Manufacturer of Each Boiler By Size:
Frequency of Inspection:
Daily
Weekly
Monthly
Quarterly
Semi-Annually
Annually
As Needed
Other
ELECTRIC HEATING (DUCT HEATERS)
Included:
Yes
No
Task(s) to be Accomplished:
Hold down the
CTRL
key on your keyboard while selecting to select more than one option.
Check Electric Coil Operation
Manufacturer's Recommended Preventive Maintenance
Visual Inspection of Duct Heater
Other:
Average # of Duct Heaters per Floor:
Manufacturer of Each Type Duct Heater by Size:
Frequency of Inspection:
Daily
Weekly
Monthly
Quarterly
Semi-Annually
Annually
As Needed
Other
AIR HANDLING EQUIPMENT PACKAGE UNITS
Included:
Yes
No
Task(s) to be Accomplished:
Hold down the
CTRL
key on your keyboard while selecting to select more than one option.
Balance Fans
Check Amperage and Voltage of Motors
Check Belt Tightness and Alignment
Check Fan and Pump Bearing Operating Temperatures
Check Heating and Cooling Coils (Clean if Necessary)
Check Supply Air Temperature
Check/Tighten all Setscrews
Clean Fan Blades and Coils
Clean Outside Air Screens, Dampers, Damper Motors, and Linkage
Complete Vibration Analysis and Excessive Noise Inspection
Inpsect Fan Blades and Vanes for Damage
Lubricate Fan and Pump Bearings
Lubricate Damper Motors and Linkage
Manufacturer's Recommended Preventive Maintenance
Replace Filters (Within Units Only)
Other:
# of Air-Handlers:
Manufacturer and Size of Each Unit by Type:
Frequency of Inspection:
Daily
Weekly
Monthly
Quarterly
Semi-Annually
Annually
As Needed
Other
ROOF TOP UNITS (INDUSTRIAL AND LOW-RISE BUILDINGS)
Included:
Yes
No
Task(s) to be Accomplished:
Hold down the
CTRL
key on your keyboard while selecting to select more than one option.
Check Amperage and Voltage of Motors
Check Belt Tightness and Alignment
Check Fan and Pump Bearing Operating Temperatures
Check Supply Air Temperature
Check/Tighten all Setscrews
Clean Coils
Complete Vibration Analysis and Excessive Noise Inspection
Inspect Coils for Damage
Lubricate Fan Bearings
Manufacturer's Recommended Preventive Maintenance
Replace Filters (Within Units Only)
Other:
# of Roof-Top Units:
Manufacturer and Size of Each Unit by Type:
Frequency of Inspection:
Daily
Weekly
Monthly
Quarterly
Semi-Annually
Annually
As Needed
Other
AIR FILTERS
Included:
Yes
No
Task(s) to be Accomplished:
Hold down the
CTRL
key on your keyboard while selecting to select more than one option.
Check Filter Manometers
Inspect Filters
Replace Filters
Other:
# Filters by Type and Size:
Manufacturer and Size of Each Type Filter:
Frequency of Inspection:
Daily
Weekly
Monthly
Quarterly
Semi-Annually
Annually
As Needed
Other
DAMPERS
Included:
Yes
No
Task(s) to be Accomplished:
Hold down the
CTRL
key on your keyboard while selecting to select more than one option.
Fire Dampers
Back Draft Dampers
Clean Dampers
Check Operation
Lubricate Bearings
Inspect Linkage
Other:
Average # of Dampers per Floor:
Frequency of Inspection:
Daily
Weekly
Monthly
Quarterly
Semi-Annually
Annually
As Needed
Other
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