Technical Site Survey

Date Performed:

MonthDayYear

RSD (Disabled Field)

Is this Survey for a MA Trial Court Location?

Customer Name:

Customer Contact:

Customer Phone:

Format: (000) 000-0000.

Quench Work Order:

Site Requirements:

Rows	Type of Unit Installed	Location of Unit	Correct electrical outlet is within 6 ft of where unit is to be installed.	Clearance and Ceiling Height meet needs	Drain Connection point readily accessible.(If Applicable)	Approximate distance from equipment location to drain in feet______ (Photo of facility drain required)(if Applicable)	Condensate pump is required.	Approximate distance from water source to unit install location.	Lift needed
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**Please trip GFI breaker on the counter top and check to ensure that dedicated outlet still works**

Comments:

Where "photo required" is noted please attach to the survey photos similar to the examples below:

Upload Photos:

Manager Name:

RSD Name/Senior FSM:

Technician Name:

Manager Email

Signature: