Quality Assurance Survey Report
To whom it may concern:
Please review the items below upon receiving and installing our product. Select N/A on any item that does not apply to the product.
Job Name: _____________________________________________________________________ Daikin Applied S.O. No. _______________
Installation address: ____________________________________________________________________________________________________
City: ___________________________________________________________________________ State: _______________________________
Purchasing contractor: __________________________________________________________________________________________________
City: ___________________________________________________________________________ State: _______________________________
Name of person doing start-up (print): ___________________________________________________________________________________
Company name: ______________________________________________________________________________________
Address: ____________________________________________________________________________________________
City/State/Zip: _______________________________________________________________________________________
Unit model number: ____________________________________________________ Unit serial number: __________________________
1. Is there any shipping damage visible? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No N/A
Location on unit ____________________________________________________________________________________
2. How would you rate the overall appearance of the product; i.e., paint, n damage, etc.?
Excellent Good Fair Poor
3. Did all sections of the unit t together properly? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No N/A
4. Did the cabinet have any air leakage? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No N/A
Location on unit ___________________________________________________________________________________
5. Were there any refrigerant leaks? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No N/A
From where did it occur? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Shipping Workmanship Design
6. Does the refrigerant piping have excessive vibration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No N/A
Location on unit ___________________________________________________________________________________
7. Did all of the electrical controls function at start-up? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No N/A
Comments _______________________________________________________________________________________
8. Did the labeling and schematics provide adequate information? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No N/A
9. How would you rate the serviceability of the product?
Excellent Good Fair Poor
10. How would you rate the overall quality of the product?
Excellent Good Fair Poor
11. How does the quality of Daikin Applied products rank in relation to competitive products?
Excellent Good Fair Poor
Comments _______________________________________________________________________________________
Please list any additional comments which could a ect the operation of this unit; i.e., shipping damage, failed components, adverse installation applications, etc. If additional comment
space is needed, write the comment(s) on a separate sheet, attach the sheet to this completed Quality Assurance Survey Report, and return it to the Warranty Department with the
completed preceding “Equipment Warranty Registration Form”.
13F-4160 (02/16) ©2016 Daikin Applied • (800) 432-1342 • www.DaikinApplied.com
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