PUMP ASSESSMENT FORMS

Pump Control Questions:

Circle or explain what function the pump serves:

Condenser
Water

Chilled
Water

Secondary
Chilled
Water

Heating
Water

Secondary
Heating
Water

Other

____________
____________

Pump ID #:

What causes the pump to initially

start?

What causes the pump to cycle?

How is the capacity controlled (VFD,

etc.)?
(If a VFD is used, attach VFD
Assessment Form to the
appropriate Pump Form)

If applicable, what is the differential

pressure control point?

If there is a lead/lag strategy,

explain:

If pumps are staged, explain:

Notes, Comments, and Observations:

PUMP ASSESSMENT FORMS

Pump Nameplate Information
Use N/A for not applicable & N/O for not obtainable or available.
Pump
Function:
(Heating
water,
condenser,
etc.)
Pump ID or
Number
Pump
Manufacturer
Model
Number
Serial
Number
Age
Impeller size
Head
pressure
Suction
Pressure
Discharge
Pressure
GPM
Motor
Manufacturer
Motor Model
#
Phase
Volts phase
to phase

Volts phase
to ground

Nameplate:

Nameplate:

Nameplate:

Nameplate:

Measured:

Measured:

Measured:

Measured:

Measured:

Measured:

Measured:

Measured:

PUMP ASSESSMENT FORMS

PUMP ASSESSMENT FORMS

Pump Function:
(Heating water,
condenser, etc.)
RLA each phase

Nameplate:

Nameplate:

Nameplate:

Nameplate:

Measured:

Measured:

Measured:

Measured:

kW

Measured:

Measured:

Measured:

Measured:

Power Factor

Measured:

Measured:

Measured:

Measured:

HP
RPM

Notes, Comments, and Observations:

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

PUMP ASSESSMENT FORMS

Pump Maintenance Checklist
if okay; Enter comment # number if deficient.
Enter document comments by # number in form provided below checklist.
Use N/A for not applicable and N/O for not obtainable or available.
Pump ID
General condition good
(clean and appear well
maintained)
No unusual noise or vibration
No water leaks
Thermometers on supply and
return.
Pressure gauges installed
across pumps and functioning
(if so, record pressures)

Suction:

Suction:

Suction:

Suction:

Discharge:

Discharge:

Discharge:

Discharge:

Pump rotation correct

Properly balanced
Strainers in place and clean?
When were the strainers last
cleaned
Piping properly insulated
Piping generally in good
condition
Valves in good condition - no
leaks
Water treatment in place and
operating

Numb
er

Comment

PUMP ASSESSMENT FORMS