32 IM 962-2
Quality Assurance Survey Form
Quality Assurance Survey Form
Quality Assurance Survey Report
To whom it may concern:
Please review the items below upon receiving and installing our product. Mark N/A on any item that does not apply to the product.
Job Name: _____________________________________________________________________ Daikin G.O. No. ____________________
Installation address: ____________________________________________________________________________________________________
City: ___________________________________________________________________________ State: _______________________________
Purchasing contractor: __________________________________________________________________________________________________
City: ___________________________________________________________________________ State: _______________________________
Name of person doing start-up (print): ___________________________________________________________________________________
Company name: ______________________________________________________________________________________
Address: ____________________________________________________________________________________________
City/State/Zip: _______________________________________________________________________________________
1. Is there any shipping damage visible? ..................................................................Ye s No N/A
Location on unit ____________________________________________________________________________________
2. How would you rate the overall appearance of the product; i.e., paint, n damage, etc.?
Excellent Good Fair Poor
3. Did all sections of the unit t together properly? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......Ye s No N/A
4. Did the cabinet have any air leakage? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......Ye s No N/A
Location on unit ___________________________________________________________________________________
5. Were there any refrigerant leaks? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......Ye s No N/A
From where did it occur? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Shipping Workmanship Design
6. Does the refrigerant piping have excessive vibration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......Ye s No N/A
Location on unit ___________________________________________________________________________________
7. Did all of the electrical controls function at start-up? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......Ye s No N/A
Comments _______________________________________________________________________________________
8. Did the labeling and schematics provide adequate information? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......Ye s No N/A
Excellent Good Fair Poor
Excellent Good Fair Poor
9. How would you rate the serviceability of the product?
10. How would you rate the overall quality of the product?
11. How does the quality of Daikin products rank in relation to competitive products?
Excellent Good Fair Poor
Comments _______________________________________________________________________________________
Please list any additional comments which could affect the operation of this unit; i.e., shipping damage, failed components, adverse installation
applications, etc. If additional comment space is needed, write the comment(s) on a separate sheet, attach the sheet to this completed Quality
Assurance Survey Report, and return it to the Warranty Department with the completed preceding “Equipment Warranty Registration Form”.