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 manufacturer’s
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.

The University of Texas ATTACHMENT “A” TO ELECTRICAL SYSTEMS

MD Anderson Cancer Center PREFUNCTIONAL CHECKLISTS AND START-UPS
26 08 13 A
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 Contractor/Entity Company Abbreviation
MD Anderson Staff MD ANDERSON
Architect/Engineer A/E
General Contractor /
GC
Construction Manager
Mechanical Contractor MC
Electrical Contractor EC
Building Automation System
BAS
Provider
Test, Adjust, and Balance Firm TAB
Commissioning Consultant CA

2. Requested Documentation Submitted:

Specified Requirement Yes No Date to be

Submitted
a) Manufacturer’s 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
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

The University of Texas ATTACHMENT “A” TO ELECTRICAL SYSTEMS

MD Anderson Cancer Center PREFUNCTIONAL CHECKLISTS AND START-UPS
26 08 13 A
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 a) Unit and General Installation Yes No Comments
dampered, fire sprinklered, fire alarmed and illuminated
(normal, emergency and battery backed-up fixtures)
14. Record Drawings updated

b) Switchgear (service entrance 1500kVA and above) and Yes No Comments

Switchboards (service entrance less than 1500 kVA)
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
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

The University of Texas ATTACHMENT “A” TO ELECTRICAL SYSTEMS

MD Anderson Cancer Center PREFUNCTIONAL CHECKLISTS AND START-UPS
26 08 13 A
MS052616 3 OF 5
 g) Final Yes No Comments
have been reviewed and accepted
3. System is ready for Functional Performance Test

5. Operational Checks:

a. These checks supplement the manufacturer’s 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 Thermometer or BAS Value Instrument Pass (Y/N)

Location Gage Value (2) Measured
(Y/N) Value (3)
(1)

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

The University of Texas ATTACHMENT “A” TO ELECTRICAL SYSTEMS

MD Anderson Cancer Center PREFUNCTIONAL CHECKLISTS AND START-UPS
26 08 13 A
MS052616 4 OF 5
 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:

The University of Texas ATTACHMENT “A” TO ELECTRICAL SYSTEMS

MD Anderson Cancer Center PREFUNCTIONAL CHECKLISTS AND START-UPS
26 08 13 A
MS052616 5 OF 5
 EXAMPLE - PREFUNCTIONAL CHECKLIST
Emergency Power System

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:
___ Prime Mover, ___ Generator, ___ Fuel System, ___Cooling System, ___Battery System,
___ Exhaust System, ___ ATS, ___ UPS

Associated Prefunctional Checklists:

___Piping, ___ Pump, ___ Exhaust Fan, ___Other________________

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 manufacturer’s
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.

The University of Texas ATTACHMENT “B” TO ELECTRICAL SYSTEMS

MD Anderson Cancer Center PREFUNCTIONAL CHECKLISTS AND START-UPS
26 08 13 B
MS052616 1 OF 6
 Contractor/Entity Company Abbreviation
MD Anderson Staff MD ANDERSON
Architect/Engineer A/E
General Contractor / Construction
GC
Manager
Mechanical Contractor MC
Electrical Contractor EC
Building Automation System
BAS
Provider
Test, Adjust, and Balance Firm TAB
Commissioning Consultant CA

2. Requested Documentation Submitted:

Specified Requirement Yes No Date to be

Submitted
a) Manufacturer’s 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
Size/Rating (kW /
continuous or standby)
Fuel Type
Voltage/Phase

4. Installation Checks:

a) Unit and General Installation Yes No Comments

1. Permanent labels affixed
2. Physical condition acceptable
3. Properly mounted with vibration isolators
4. Factory alignment appears correct
5. Field alignment complete
6. Maintenance access acceptable
7. Fuel piping and/or prime mover exhaust system are
properly supported (independent of prime mover and/or
generator)
8. Recor Drawings updated
9. Equipment clean
10. Equipment room properly ventilated, air-conditioned,
heated, fire/smoke wall separated, fire/smoke
dampered, fire sprinklered, fire alarmed and illuminated

The University of Texas ATTACHMENT “B” TO ELECTRICAL SYSTEMS

MD Anderson Cancer Center PREFUNCTIONAL CHECKLISTS AND START-UPS
26 08 13 B
MS052616 2 OF 6
 a) Unit and General Installation Yes No Comments
(normal, emergency and battery backed-up fixtures)
11. All equipment properly identified and labeled

b) Prime Mover Yes No Comments

1. Unit able to run on diesel fuel or a combination of
natural gas and diesel fuel
2. Air cleaner and oil filter(s) installed
3. Vibration isolators active
4. Proper oil type used, with level correct
5. Exhaust duct installed with proper insulation and
silencer/muffler
6. Exhaust system discharges to outside
7. Condensables able to be removed from exhaust system
and discharged properly
8. Combustion and/or ventilation air louvers installed
correctly
9. Cooling water radiator ducted to inlet louver

c) Generator Yes No Comments

1. Bearings lubricated
2. Rotor and stator in proper condition
3. Voltage regulator installed
4. Main breaker installed, rated at full load capacity
5. Instrument panel is mounted on unit
6. Remote annunciator panel installed
7. Generator auxiliary panel (dedicated to generator room
equipment/lighting) is installed

d) Fuel System Yes No Comments

1. Piping Prefunctional Checklist complete and accepted
2. Day tank installed, with electric pump, hand pump, and
bypass piping/valves
3. Above ground fuel tank installed, with pump(s)
4. Monitoring system installed
5. MD ANDERSON Environmental reviews complete and
accepted

e) Battery Charger and Batteries Yes No Comments

1. Batteries installed in a nonmetallic rack (wall mounted)
adjacent to the prime mover
2. Battery electrolyte level is correct
3. Automatic trickle battery charger is installed (wall
mounted) adjacent to battery bank
4. Battery cable connections are tight, terminals are clean

f) Automatic Transfer Switch Yes No Comments

1. ATS rated for operation at the same output as the
emergency generator, capacity is greater than total
system transferred load
2. Transferred loads identified at panel, agrees with listed

The University of Texas ATTACHMENT “B” TO ELECTRICAL SYSTEMS

MD Anderson Cancer Center PREFUNCTIONAL CHECKLISTS AND START-UPS
26 08 13 B
MS052616 3 OF 6
 f) Automatic Transfer Switch Yes No Comments
loads
3. ATS installation is complete

g) Electrical and Controls Yes No Comments

1. Panel devices labeled and wiring tagged per Contract
Documents
2. Unit mounted instrument panel includes:
AC voltmeter
Ammeter
V-a selector switch
Frequency meter
Running time meter
Voltage adjusting rheostat
Exciter overload protection
Warning lights and alarms
3. Batteries provided with electronic sensing device for
remote notification of battery conditions
4. I/O devices labeled and wiring tagged per Contract
Documents
5. Digital inputs and outputs operational
6. All electrical connections tight
7. Proper grounding installed for the electrical system,
equipment, components, and unit
8. Safeties in place and operable
9. Sensors, transmitters, gages, etc., installed
10. Sensors calibrated (see below)
11. Control system interlocks hooked up and functional
12. All control devices and wiring complete
13. Lightning protection installed

h) Final Yes No Comments

1. Start-up report completed and attached with this
Prefunctional Checklist
2. List of items/systems served by the emergency power
system is attached
3. Fuel tank(s) full
4. Safeties and safe operating ranges for this equipment
have been reviewed and accepted
5. Sequence of operation adequately indicates all
information
6. System is ready for Functional Performance Test

5. Operational Checks:

f. These checks supplement the manufacturer’s list. This is not the Functional
Performance Test.

Operational Checks Yes No Comments

1. Associated Prefunctional Checklists are complete and
accepted
2. ATS operates correctly
3. Resistance check(s) complete with results attached

The University of Texas ATTACHMENT “B” TO ELECTRICAL SYSTEMS

MD Anderson Cancer Center PREFUNCTIONAL CHECKLISTS AND START-UPS
26 08 13 B
MS052616 4 OF 6
 Operational Checks Yes No Comments
4. Fuel system operates correctly
5. Ignition and battery systems operate correctly
6. Cooling system operates correctly
7. Specified point-to-point checks have been completed
and documentation record submitted for this system

6. Sensor and/or Actuator Calibration:

g. 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.

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

Sensor/Actuator Verification Table

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

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

The University of Texas ATTACHMENT “B” TO ELECTRICAL SYSTEMS

MD Anderson Cancer Center PREFUNCTIONAL CHECKLISTS AND START-UPS
26 08 13 B
MS052616 5 OF 6
 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:

The University of Texas ATTACHMENT “B” TO ELECTRICAL SYSTEMS

MD Anderson Cancer Center PREFUNCTIONAL CHECKLISTS AND START-UPS
26 08 13 B
MS052616 6 OF 6