PROJECT NAME : Holiday Inn Benoa - Bali DATE:

PROJECT NO : BY:

Room No :
Location : Chiller No :
1 Model Type / Manefacturer : .
Capacity :
2 Refrigerant Type : ..
3 Compressor :
a. Compression Type :
Centrifugal Screw Reciprocating Scroll .........................
b. Casing Type
Hermetic / Semi - Hermetic Screw Reciprocating Scroll .........................
c. Electrical Chracteristic
d. Starter
Y - Closed Transition Y - Open Auto - Transformer ..........................................
e. Oil level checked ..........................................................................................
f. Oil failure switch differential ..........................................................................................
g. Bearing temperature ..........................................................................................
h. Chilled water Control setting ..........................................................................................
i. Condenser Water Control Setting ..........................................................................................
j. Low Pressure Cutout Setting ..........................................................................................
k. HIgh Pressure Cutout Setting ..........................................................................................
4 Temperature and Pressure Readings Type.
Conventional Gauge/Thermostat Digital
The Following Readings Type. Design Data Actual Data

a. Cooler Water Temp. In

b. Cooler Water Temp. Out
c. Cooler Water Pressure In
d. Cooler Water Pressure. Out
e. Cooler Water Flow Rate
f. Condenser Water Temp. In
g. Condenser Water Temp. Out
h. Condenser Water Pressure. In
i. Condenser Water Pressure. Out
j. Condenser Water Flow Rate
k. Evaporating Temp/Pressure
l. Section Line Temp/Pressure
m. Discharge Line (Condensing Temp/Pressure)
n. Oil Temp Pressure
o. Voltage/Ampere per Phare
p. kW Input
q. RPM
r. Crankcase Heater Amp/Temp
s. Liquid Line Temp (Reciprocating)
5. Refrigeration
Refrigerant Level Checked Yes No
Relief Valve Setting Yes No
Unloader Set Point .
% Cylinder Unloaded (resiprocating) .
% OF Inlet Guide Van .
Vane Position Yes No
Demand Limit .
Low Temp Cutout Setting .
5 Follow Switch
Cooler Water Yes No

Chiller Inspection - Testing and Commissioning Document - TBI Project Management 1

 Condenser Water Yes No
6 Motorized Valve
Cooler Water Yes No
Condenser Water Yes No
7 Vibration Isolator Type Spring Neoprene Rubber Pad
8 Flexible Pipe Yes No
9 Condition of Chiller
Unsatisfactory Poor Satisfactory Good Verry Good
10 Will Require Replacement in
Immediately Withing 12 Months 0-5 Years 5-10 Years 10+ Years

11 General Comments

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Chiller Inspection - Testing and Commissioning Document - TBI Project Management 2

PROJECT NAME : Holiday Inn Benoa - Bali DATE:
PROJECT NO : BY:

Room No :
Location :

1 Quantity ..................................................................................................................................................................................set
Type / Manufacturer .......................................................................................................................................................................................
2 Duty : From Name Plate ...........................................................................................................................................
Water Cooling Capacity ...........................................................................................................................................
Fan Motor Make/Frame ...........................................................................................................................................
Fan Motor MP (kW) ...........................................................................................................................................
Volts and Ampere per Phase ...........................................................................................................................................
Motor and fan Sheave Diam/Bore ...........................................................................................................................................
No.of Belts/Make/Size ...........................................................................................................................................
Gear Box Specification ...........................................................................................................................................
Fan RPM ...........................................................................................................................................
3 The Visible Parts are clean. Yes No
4 Water Strainer is fitted in. Yes No
5 All pipes are connected correctly
Supply pipe Yes No
Return pipe Yes No
Make up pipe Yes No
Over flow & Drain Yes No
Equalizer pipe Yes No
6 Vibration isolators are provided. Yes No
7 All Units water levels are the same. Yes No
8 Open the drain at the buttom to see the dirt. Yes No
9 Open Shut off valve to check the float valve operation. Yes No
10 Rotate sprinkler (if any) by hand to see the free rotation. Yes No
11 Rotate the the fan by hand to be sure of free rotation and ample tip clearance. Yes No
12 Measure the supply voltage and check if power is suitaed with. Yes No
13 Run the fan monentarity to check the correct rotation. Yes No
14 Check for correct oil level if gear driven. Yes No
15 Check belt correct transion is belt driven. Yes No
During operation, all units supply and return water are correctly balanced and
16 Yes No
always
balanced even interchanging stand by and operation units.
17 During operation, The are free Unsual Noise/Vebration. Yes No
18 Water temp, control thermostat. Yes No
19 Cooling Tower Opertion Data Yes No
The following readings type. Design Data Actual Data
a. Air Flow Rate
b. Water Flow Rate
c. Inlet Static Pressure
d. Outlet Static Pressure
e. Average Entering Wet Bulb
f. Avarage Leaving Wet Bulb
g. Ambient Wet Bulb/Dry Bulb
h. Consumption Power/Amperages
20 During operation, there are free from unsual noise / vibration. Yes No
21 Manual/ Motorized valve.
Inlet Yes No
Outlet Yes No
22 Flexible pipe. Yes No
23 Condition of Cooling Tower
Unstatisfactory Poor Stisfactory Good Verry Good

Cooling Tower Inspection - Testing and Commissioning Document - TBI Project Management 3
 24 Will Require replacement in
Immediatelly Within 12 Mounths 0-5 years 5-10 years 10+ years

25 General Comments

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Cooling Tower Inspection - Testing and Commissioning Document - TBI Project Management 4
PROJECT NAME : Holiday Inn Benoa - Bali DATE:
PROJECT NO : BY:

Room No :
Location :

1 Model : Type manufacturer ..

2 Duty : From Name Plate ..
Pump Motor Make/ Frame ..
Pump Motor MP (kW)/ RPM ..
Volts and Ampere Per Phase ..
Pump Specification ..
Impeller Diameter ..
Seal Type ..
3 The external Parts of the pump are clean. Yes No
4 The motor rotating dirtection is correct. Yes No
5 All components, bolts, fixings etc. Are secure and no distoration has taken place on the -
base in tightening. Yes No
6 The impeller is free to rotate. Yes No
7 The level and plumb of pump and motor shaft and slide rail are correct.
Direct-drive pumps require particular attention in this respect,
with reference to manufactures recomendations. Yes No
8 The anti-vibration mountings have correct deflection. Yes No
9 The correct drive is fitted. Yes No
10 The pipework imposes no strain at the pump connections. Yes No
11 The couplings are secure and their alignment is correct. Yes No
12 The bearings are clean. Yes No
13 The lubricant is of the correct grade and fresh. (if Applicable) Yes No
14 The coolant is available at the bearing or seal. (if Applicable) Yes No
15 The glands, where fitted, are correctly packed and the gland nuts -
are not more than finger right, pending adjustment to correct drip rate after star-up. (if Applica Yes No
16 Drive guard are scurely fitted with proper access for tachometer readings. Yes No
17 Pressure gauge are fitted at both the suction and discharge points of the pump to-
facilitate head test to confirm inferred pump performance. Yes No
18 Pipe flexible connector : Yes No
19 Pipe insulation : Good Fair No Acceptable
20 Pipework : Good Fair No Acceptable
Replace : Yes No
21 Power supply wiring :
Rewire : Yes No
22 Power supply isolators :
Provided : Yes No
Working : Yes No
23 Setting of variable speed drive are correctly done as per design : Yes No
24 Pump Operation Data
The following readings type Design Data Actual Data
a Water Pressure In
b Water Pressure Out
c Water Pressure Drop
d Water Flow Rate
25 Condition of Pump
Unstatisfactory Poor Stisfactory Good Verry Good

26 General Comments

Chilled Water/ Condenser Water Pump Inspection - Testing and Commissioning Document - TBI Project Management 5


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Chilled Water/ Condenser Water Pump Inspection - Testing and Commissioning Document - TBI Project Management 6
PROJECT NAME : Holiday Inn Benoa - Bali DATE:
PROJECT NO : BY:

Room No :
Location : Fan Coil No. .................................................................................................

1 Model : Type manufacturer................................../................................

2 Duty : From Name Plate..............................................................
Water Cooling Capacity.................................................................
Fan Motor MP (kW)...................................................................................
Power Supplay...............................................................................................

Refrigerant ............................................................................
Other.....................................................................................
3 Control Valve : Manual / Selenoid/ Modulating Other
Manufacturer .
4 Thermostat : Type .. Speed Selection .. Yes / No
Manufacturer : Type .

5 Air Filter Type : Aluminium / Fiber / Other ..

Condition :
6 Balancing Valve : Yes No
7 Water Strainer Clean Yes No
8 Flexible Pipe Connector Yes No
9 Pipe Insulation Good Fair Not Acceptable
10 Pipe Label Yes No
11 Return Air Provision :
Type : Chamber / Duct Size
12 FCU Fan Noisy/ O.K/ Replace
13 FCU Operation Good Fair Not Acceptable
Replace Yes No
14 FCU Casing Good Fair Not Acceptable
Replace Yes No
15 Supply Grill Good Fair Not Acceptable
Replace Yes No
16 Pipe Work Good Fair Not Acceptable
Replace Yes No
17 Duct Work : Condition : Good Fair Not Acceptable
18 Drain Pan with insulation and slide to drain pipe Yes No
19 FCU - Coil Condition Good Fair Not Acceptable
20 Flexible Duct Connector Yes No
21 Power Supply Wiring
Rewire : Yes No
22 Power Supply Isolators:
Provided Yes No
Working Yes No
23 Beside Control Panel
Provided Yes No
Working Yes No
24 Anti- vibration device
Rubber pad Yes No
Spring isolator Yes No
Anti-vibration device have correct deflection Yes No
25 FCU Operation Data
The following readings type: Design Data Actual Data
a Air volume (L/S) / Wind Speed (M/S)

b Entering air Temperature (C/ %RH)

Fan Coil Units Inspection - Testing and Commissioning Document - TBI Project Management 7
 c Leveling air Temperature (C/ %RH)

d Chilled water temperatureC (in/out)

e Chilled water flow rate (L/S)

f Current (Voltage / Ampere)

26 Condition of Fan coil unit

Unstatisfactory Poor Stisfactory Good Verry Good
27 Will Require replacement in
Immediatelly Within 12 Mounths 0-5 years 5-10 years 10+ years

28 General Comments

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Fan Coil Units Inspection - Testing and Commissioning Document - TBI Project Management 8
PROJECT NAME : Holiday Inn Benoa - Bali DATE:
PROJECT NO : BY:

Room No :
Location : Fan Coil No. .................................................................................................

1 Model : Type manufacturer................................../................................

2 Duty : From Name Plate..............................................................
Motor H.P.................................................................
Cooling Load...................................................................................
Motor pulley dia. (mm) ...............................................................................................

Blower pulley dia. (mm) ...............................................................................................

Fan Motor Make/ Fram ...............................................................................................

Fan Motor KW/RPM ...............................................................................................

Motor Data (Voltage/ Ampere/ Hz) .....................................................................................
3 Control Valve : Manual / Selenoid/ Modulating Other
Manufacturer .
4 Thermostat : Type .. Speed Selection .. Yes / No
Manufacturer : Type .

5 Air Filter Type : Aluminium / Fiber / Other ..

Condition :
6 Balancing Valve : Yes No
7 Water Strainer Clean Yes No
8 Flexible Pipe Connector Yes No
9 Thermostat on Both Supply & Return chilled water pipe Yes No
10 Pressure Gauge on Both Supply & Return chilled water pipe Yes No
11 Pipe Insulation Good Fair Not Acceptable
12 Pipe Label Yes No
13 Return Air Provision :
Type : Chamber / Duct Size
14 AHU Fan Noisy/ O.K/ Replace
15 AHU Operation Good Fair Not Acceptable
Replace Yes No
16 AHU Casing Good Fair Not Acceptable
Replace Yes No
17 Belt Tension Good Fair Not Acceptable
Re-adjust Yes No
18 Pipe Work Good Fair Not Acceptable
Replace Yes No
19 Duct Work : Condition : Good Fair Not Acceptable
20 Drain Pan with insulation and slide to drain pipe Yes No
21 Discharge damper is correct position Yes No
22 Outside / Return Air Damper is correct position Yes No
23 Flexible Duct Connector Yes No
24 Power Supply Wiring
Rewire : Yes No
25 Power Supply Isolators:
Provided Yes No
Working Yes No
26 Beside Control Panel
Provided Yes No
Working Yes No
27 Anti- vibration device
Rubber pad Yes No
Spring isolator Yes No

Air Handling Unit Inspection - Testing and Commissioning Document - TBI Project Management 9
 Anti-vibration device have correct deflection Yes No
28 AHU Operation Data
The following readings type: Design Data Actual Data
a Air volume (L/S) / Wind Speed (M/S)

b Total air flow rate

c Discharge / suction static pressure

d Outside / Return air flow rate

e Air filter pressure drop

f Cooling coil pressure drop

g Outside air temperature dry bulb/ wet bulb

h Return air temperature dry bulb/ wet bulb

i Entering air Temperature (C/ %RH)

j Leveling air Temperature (C/ %RH)

k Chilled water temperatureC (in/out)

l Chilled water flow rate (L/S)

m Current (Voltage / Ampere)

26 Condition of Air Handling unit

Unstatisfactory Poor Stisfactory Good Verry Good

27 General Comments

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Air Handling Unit Inspection - Testing and Commissioning Document - TBI Project Management 10
PROJECT NAME : Holiday Inn Benoa - Bali DATE:
PROJECT NO : BY:

Location :

1 Model : Type manufacturer .. Fan Type ..

2 Duty : From Name Plate .. Fan RPM ..
Motor HP .. Fan Motor kW/ RPM ..
Speed .. Fan Motor Make / Frame ..
Power Supply .. Delivery Flow Rate ..
Duty .. Air Operating Temp ..
Blower pulley dia (mm) .. No. of Belts / Make Size ..

Motor pulley dia. (mm) .. Other ..

3 The external parts of the fan are clean. Yes No

4 The follow direction is correct. Yes No

5 All components, bolts, fixings etc. Are secure and no distoration has taken place on the -
base in tightening. Yes No

6 Blower wheel is free to rotate. Yes No

7 The level and plumb of pump and motor shaft and slide rail are correct. Yes No

8 Anti-vibration device
Rubber pad : Yes No

Spring isolator : Yes No

9 The anti-vibration mounting have correct deflection. Yes No

10 The correct drive is fitted. Yes No

A drive guide is fitted, Access for speed measurement.

11 The pulley and couplings are scure and their aligment is correct. Yes No

12 The belts are tensioned and matched. Yes No

13 The berings are clean. Yes No

14 The lubricant is of the correct grade and fresh. Yes No

15 The coolant is available at the bearing or seal. Yes No

16 Satisfactory operation of inlet guide fanes averfull range of movement. Yes No

17 Power supply wiring.

Revise : Yes No

18 Power supply isolator.

Provide : Yes No

Working : Yes No

19 Motor,device and fan free from vibration or undue noise. Yes No

20 Motor running current on all phases. Yes No

21 No seepage of lubricant from housing. Yes No

22 On multi-speed motors check reduced speed rev/s and motor running currents. Yes No

23 Supply & Exhaust Fan Operation Data

The following readings type Design Data Actual Data
a Air volume (L/S) / Wind speed (M/S)
b Current R,S,T (Voltage/ Ampere) per phase
c Static Pressure In / Out
d Total Static Pressure
e Full Loads amps/ service factor
23 Condition of Supply & Exhaust Fan
Unstatisfactory Poor Stisfactory Good Verry Good

24 General Comments

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Supply/ Exhaust Fan Inspection - Testing and Commissioning Document - TBI Project Management 11
PROJECT NAME : Holiday Inn Benoa - Bali DATE:
PROJECT NO : BY:

VAV Box No. .................................................................................................

Location :

1 Model Type/Manufacturer ..
2 Duty : From name plate .. Motor Data ( Voltage / Ampere/ Hz) ..
Motor H.P .. Inlet diameter ..
Motor Pulley dia. (mm) ..
Blower pulley dia. (mm) ..
Fan Motor Make / Frame ..
Fan Motor kW/ RPM ..
Capacity ..
3 Air Modulation :
Ceiling by pass type Yes No

Regulating type Yes No

4 Pressure independent type (Electronic) Yes No

5 Control type
Pneumatic (Pressure depandent) Yes No

Electric (Pressure depandent) Yes No

Electronic (Pressure depandent) Yes No

6 Electronic Actuator Yes No

7 Control Transformer Yes No

8 Thermostat Yes No

9 Power and control wire installed properly Yes No

10 Flexible duct properly connected (no leakage) Yes No

11 Multiple outlet box equipped Yes No

12 AHU Operation Data

The following readings type: Design Data Actual Data
a Air volume (L/S) / Wind Speed (M/S)

b Air filter pressure drop

c Total air flow rate

d Discharge / Suction static pressure

e Outside / Return air flow rate

f Cooling coil pressure drop

g Outside air temperature dry bulb/ wet bulb

h Return air temperature dry bulb/ wet bulb

i Entering air Temperature (C/ %RH)

j Leveling air Temperature (C/ %RH)

k Chilled water temperatureC (in/out)

l Chilled water flow rate (L/S)

m Current R,S,T (Voltage / Ampere)

n Occupied/ Un- Occupied mode Temp. setting point

o Max/ Min Supply air Flow rate

p By pass air flow rate

q Variable speed drive (Max/ Min) - Speed/ Hertz

13 Condition of VAV Box (Terminal Unit)

Unstatisfactory Poor Stisfactory Good Verry Good

14 General Comments

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VAV Box Inspection - Testing and Commissioning Document - TBI Project Management 12
PROJECT NAME : Holiday Inn Benoa - Bali DATE:
PROJECT NO : BY:

Room No :
Location : Fan Coil No. .................................................................................................

1 Model : Type manufacturer................................................................

As Tested.......................................................................................................
2 Duty : From Name Plate..................................................................
Motor pulley dia (mm).....................................................................................
Motor HP ...................................................................... Blower pulley dia (mm).....................................................................................
Cooling load.................................................................. Air volume (L/S).............................................................................................
Power Supply......................................................................
Entering air temperature (C/%RH)...............................................................

Refrigerant .................................................................... Leaving air temperature (C/%RH)...............................................................

Other.............................................................................. Current R,S,T (A).....................................................................................................
3 Expansion Device : Expansion Valve Capillary Tube Other.................
4 High & Low pressure switch provided : Yes No

5 Filter Drier : Yes No

6 Sight Glass Condition : Good Fair Not Accept

7 Thermostat : Type....................................... Speed selector.................................................................................. Yes/No
Manufacturer : ..............................................................Type.....................................................................................
8 Filter type : Aluminium Fiber Other
Condition :
9 Pipe Insulation Condition : Good Fair Not Accept

Thickness.......................................................mm.
10 Return air provision :
Type : Chamber/Duct Size Yes No

11 FCU Fan/Unit cooler motor

Motor HP/kW...............................................................................................
Power Supply..............................................................................................
12 FCU Fan/Unit cooler : Noisy/O.K/Replace :
Chamber/Duct Size..................................................................................................................
13 FCU/Unit Cooler operation : Good Fair Not Accept
Replace : Yes No

14 FCU/Unit Cooler casing : Good Fair Not Accept

Replace : Yes No

15 Supply Grill : Good Fair Not Accept

Replace : Yes No

16 Pipework : Good Fair Not Accept

Replace : Yes No

17 Duct work condition : Good Fair Not Accept

18 Electric defrast working condition. Yes No

19 Power supply wiring.

Revise : Yes No

20 Power supply isolator / Disconnected switch for service.

Provide : Yes No

Working : Yes No

22 Liquid & suction line service valve

Provide : Yes No

27 General Comments

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DX Split AC Cold Room Unit 13

Inspection - Testing and Commissioning Document - TBI Project Management
PROJECT NAME : Holiday Inn Benoa - Bali DATE:
PROJECT NO : BY:

Room No :
Location :

1 Location of piping ...........................................................................................................................................

Under ground Above ground
2 Piping System ...........................................................................................................................................
3 Type of Piping ...........................................................................................................................................
4 Material ...........................................................................................................................................
Corrrect No Correct
5 Diameter ...........................................................................................................................................
Corrrect No Correct
6 Piping support.
- Type of hanger ...........................................................................................................................................
Yes No

- Distance between sopport or hanger.

Horizontal..............................mm Yes No

Vertical..................................mm Yes No

7 Piping Sleeve Yes No

8 Piping Installation.

- Vibration Yes No

- Dynamic force Yes No

- Expansion Yes No

- Excessive weight Yes No

- Pipe movement Yes No

- Any damage ...........................................................................................................................................

9 Fitting
- Flanged Yes No

- Welding Yes No

- Hub and Spigot Yes No

- Threaded Yes No

- Leakage Yes No

- Thrust block Yes No

- Any damage ...........................................................................................................................................

10 Valve.
Type of valve ...........................................................................................................................................
Class ...........................................................................................................................................
Location ...........................................................................................................................................
Type of joint Threaded Flanged

Leakage Yes No

No. Leakage Yes No

Any damageVibration Yes No

Cause ...........................................................................................................................................
...........................................................................................................................................
Sound Yes ..........................................................
Support No ...........................................................
Accessible Yes No
11 Hydrostatic Test Yes No

12 Painting Yes No

13 Support Yes No

14 Pipe Label Yes No

15 Condition of Piping & Valve

Unstatisfactory Poor Stisfactory Good Verry Good
16 Will Require replacement in
Immediatelly Within 12 Mounths 0-5 years 5-10 years 10+ years
17 Insulation

Condensation Yes No
Cause of condensation ..........................................................................................
Any damage ..........................................................................................
18 Condition of Insulation
Unstatisfactory Poor Stisfactory Good Verry Good

19 General Comments

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Piping and Valve Inspection - Testing and Commissioning Document - TBI Project Management 14
 PT.Total Bangun Persada PT.Tanjung Benoa Indonesia Intercontinental Hotel Group

Piping and Valve Inspection - Testing and Commissioning Document - TBI Project Management 15