Functional Performance Testing Compliance Form

CALGreen Commissioning Requirement 5.410.2.4, Functional Performance Testing
5.410.2.4 Functional performance testing. [N] Functional performance tests shall demonstrate the correct installation and operation of each component, system, and system-to-system interface in accordance with the approved plans and specifications. Functional performance testing reports shall contain information addressing each of the building components tested, the testing methods utilized, and include any readings and adjustments made.
Test forms have been developed for each piece of commissioned equipment and system and include the checked elements listed below. These tests have been executed with deficiencies corrected.

	FUNCTIONAL TEST ELEMENTS	INCLUDED
1.	Date and parties participating	□
2.	Signature block attesting test is complete and accurate	□
3.	Prerequisites	□
4.	Precautions	□
5.	Instrumentation required	□
6.	Reference to the source of what is being confirmed (sequences, packaged features, etc.)	□
7.	Detailed step-by-step test instructions	□
8.	Acceptance criteria	□
9.	Results	□
10.	Confirmation of returning to normal	□
11.	Deficiency list	□

Cx Coordinator Signature		Date

FUNCTIONAL PERFORMANCE TESTING
COMPLIANCE FORM

REPORT # (e.g., FPT-003)	SYSTEM/EQUIPMENT TEST REPORT (See minimum report requirements on page 2 of this form.)	PAGE/TAB # IN COMMISSIONING REPORT

THIS FORM IS TO COMPLETED FOR THE TIME OF INSPECTION

Project Address: _________________________________________________________
Permit Number: _____________________________
List the functional test reports below for all systems to be tested (see Form 5.4-8.1, item #9).
Minimum Requirements for Test Report

1. Date and Party — Identification of the date of the test and the party conducting the test.
2. Signature Block — Signature of the designated commissioning lead and the equipment-installing contractor attesting that the recorded test results are accurate.
3. Prerequisites — Any conditions or related equipment checkout or testing that needs to be completed before conducting this test.
4. Precautions — Identification of the risks involved to the test team members and the equipment and how to mitigate them.
5. Instrumentation — Listing of the instrumentation and tools necessary to complete the test.
6. Reference — In each procedure item, identify the source for what is being confirmed (e.g., sequence of operation ID, operating feature, specification requirement, etc.)
7. Test Instructions — Step-by-step instructions of how to complete the test, including functions to test and the conditions under which the tests should be performed.
8. Acceptance Criteria — Measurable pass/fail criteria for each step of the test, as applicable.
9. Results — Expected system response and space to document the actual response, readings, results, and adjustments.
10. Return to Normal — Instructions that all systems and equipment are to be returned to their as-found state at the conclusion of the tests.
11. Deficiencies — A list of deficiencies and how they were mitigated.

Commissioning Agent Acknowledgment I have reviewed the test reports listed above and verified that they are complete; these tests have been executed with deficiencies corrected.
Name: _______________________________
Company Name (if applicable): _______________________________
Agent's Signature: _______________________________	Date: ___________

SYSTEMS MANUAL COMPLIANCE FORM

CALGreen Std. BSC-5.4-10 10-08-10

CALGreen Commissioning Requirement 5.410.2.5.1, Documentation and Training—Systems Manual
5.410.2.5.1 Systems Manual. [N] Documentation of the operational aspects of the building shall be completed within the systems manual and delivered to the building owner or representative. The systems manual shall include the following:
(See elements checklist below.)

	SYSTEM MANUAL ELEMENTS	INCLUDED
1.	Site information including facility description, history, and current requirements	□
2.	Site contact information	□
3.	Basic operations and maintenance and troubleshooting	□
4.	Systems covered include major systems listed under the BOD	□
5.	Site equipment inventory and maintenance notes	□
6.	Special inspection verifications	□
7.	Other resources and documentation	□

Owner or Owner's Representative Signature		Date

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