EXAMPLE - PREFUNCTIONAL CHECKLIST

Switchgear, Panelboards, Motor Control Centers, Transformers

Project: _____________________________________ Project #:_____________________

Identification of Equipment or System: _________________________________________

Location of Equipment or System: _______________________________________________

Specification Section: ____________________ Detail/Drawing Number: _______________

Manufacturer / Supplier: ________________________________________________________

This Date: __________________ Inspection Requested for (Date): __________________


Prefunctional Checklist Number: __________________

Components Included: ____Disconnects ____Fuses ____Meters ____Other

__________________________________________________

Associated Prefunctional Checklists: __________________ __________________

1. General:

a. The above systems and components integral to this equipment are complete and ready for
Functional Performance Tests. The Prefunctional Checklist items are complete and have
been checked off only by parties having direct knowledge of the event, as indicted below,
respective to each responsible contractor. This Prefunctional Checklist is submitted for
approval and is subject to the attached list of outstanding items not completed successfully.
Submit a Deficiency Form upon completion of any outstanding or deficient items. None of the
outstanding items preclude safe and reliable functional tests being performed.

b. ___ Deficiency Form attached.

c. This Prefunctional Checklist does not take the place of the manufacturers recommended
checkout and Start-up procedures or report.

d. Contractors assigned responsibility for sections of the Prefunctional Checklist shall be
responsible to ensure that their subcontractors complete and check off their Checklist items.

e. Prefunctional Checklist items shall be completed as part of Start-up and initial checkout,
preparatory to functional testing.

Contractor/Entity Company Abbreviation
MD Anderson Staff MD ANDERSON
Architect/Engineer A/E
General Contractor / Construction
Manager

GC
Mechanical Contractor MC
Electrical Contractor EC
Building Automation System
Provider

BAS
Test, Adjust, and Balance Firm TAB
Commissioning Consultant CA


2. Requested Documentation Submitted:

Specified Requirement Yes No Date to be
Submitted
a) Manufacturers Product Data including Performance Data and
Shop Drawings, as approved by Architect/Engineer

b) Required Test Reports and/or Certifications
c) Installation and Start-up Manual and Plan
d) Wiring Diagrams, Control Schematics and Sequences
e) Operating and Maintenance Manual Content for Applicable
System

f) Equipment Matrix


3. Equipment Verification:

Item Specified Submitted Installed
Manufacturer
Model Number
Serial Number
Service
Equipment Rating (amps)
Voltage/Phase


4. Installation Checks:

a) Unit and General Installation Yes No Comments
1. Permanent labels affixed
2. Physical condition acceptable, no visible damage, cabinets
in place

3. Properly mounted on equipment pad and anchored
4. Maintenance access acceptable
5. Interior clean and dry
6. Meter(s) installed per Contract Documents
7. Disconnects installed and labeled
8. Disconnects are pad lockable in open position
9. Circuit breakers installed and labeled
10. Fuses installed
a) Unit and General Installation Yes No Comments
11. Conduits installed and connected
12. Cable/conduit routing does not obstruct access
13. Equipment room properly ventilated, air-conditioned, heated,
fire/smoke wall separated, fire/smoke dampered, fire
sprinklered, fire alarmed and illuminated (normal, emergency
and battery backed-up fixtures)

14. As-built drawings updated


b) Switchgear (service entrance 1500kVA and above) and
Switchboards (service entrance less than 1500 kVA)
Yes No Comments
1. Free standing metal enclosure
2. Cobber buses
3. Penetration to utility service area and equipment per code



c) Distribution Panelboards and other Panelboards Yes No Comments
1. Tin plated copper buses
2. Each circuit identified and labeled
3. Space for additional circuits exist



d) Motor Control Centers Yes No Comments
1. Tin plated copper buses
2. Main breakers installed and labeled
3. Each circuit identified and labeled



e) Transformers Yes No Comments
1. Dry type installed
2. Unit properly labeled and identified




f) Electrical and Controls Yes No Comments
1. Panel devices labeled and wiring tagged per Contract
Documents

2. I/O devices labeled and wiring tagged per Contract
Documents

3. Digital inputs and outputs operational
4. All electrical connections tight
5. Proper grounding installed for the electrical system,
equipment, components, and unit

6. Safeties in place and operable
7. Sensors, transmitters, gages, etc., installed
8. Sensors calibrated (see below)
9. Control system interlocks hooked up and functional
10. All control devices and wiring complete
11. Lightning protection installed
f) Electrical and Controls Yes No Comments
12. Surge protection installed


g) Final Yes No Comments
1. Start-up report completed and attached with this
Prefunctional Checklist

2. Safeties and safe operating ranges for this equipment have
been reviewed and accepted

3. System is ready for Functional Performance Test



5. Operational Checks:

a. These checks supplement the manufacturers list. This is not the Functional Performance
Test.

Operational Checks Yes No Comments
1. Associated Prefunctional Checklists are complete and
accepted

2. Fuses are good
3. Resistance check(s) complete with results attached
4. Disconnect switch operates smoothly with full contact
5. Specified point-to-point checks have been completed and
documentation record submitted for this system




6. Sensor and/or Actuator Calibration:

a. All field-installed temperature sensors, pressure sensors, meters, and gages, and all
actuators and valves on this piece of equipment shall be calibrated. Sensors installed in the
unit at the factory with calibration certification provided are not required to be field calibrated.

b. All test instruments have had a certified calibration within the last 12-months: Y / N

c. Sensor/Actuator Verification Table

Sensor or Actuator Correct
Location
(Y/N)
(1)
Thermometer or
Gage Value
BAS Value
(2)
Instrument
Measured
Value (3)
Pass (Y/N)





1) Thermometer/Gage reading is the reading of the permanently mounted instrument on the
equipment.
2) BAS is the Building Automation System. Instrument = testing instrument.
3) All sensors are calibrated within required tolerances ___ YES ___ NO

FINAL SIGN-OFF

Contractors attest that the above items have been verified and meet the requirements of the
Contract Documents except as noted on the attached Deficiency form.

General Contractor: Print Name:


Signature:


Title:


Date:



Electrical Subcontractor Print Name:


Signature:


Title:


Date:



Other Subcontractor: Print Name:


Signature:


Title:


Date:



Prefunctional Checklist received and reviewed for completeness by MD ANDERSON
representatives. Functional Performance Test can proceed.

MD ANDERSON: Print Name:


Signature:


Title:


Date:



MD ANDERSON: Print Name:


Signature:


Title:


Date: