Chiller Installation Responsibility Pre-Start-up Checklist

Please submit checklist 72 hours prior to start-up date (automatically sends to

    The following checklist outlines the minimum required items to be completed by the company responsible for chiller installation. Every applicable item on this list must be complete prior to the scheduling of the chiller startup if a startup was purchased from Glen Dimplex Thermal Solutions (GDTS). Be sure to complete, sign and fax this checklist to ‘Medical Service’ at GDTS (269‐349‐8951), prior to on‐site start‐up. Not returning this form completed and/or failure to have all items completed prior to start‐up may result in additional start‐up charges to the signee of this form.

    GDTS requires a minimum 72 hours notice after this checklist has been received before the startup can take place to allow scheduling time with local service. Paid factory technician startup visits require a minimum two weeks notice for travel coordination and scheduling. Use only the services of a qualified refrigeration mechanic for inspection and maintenance checks or service operations. Refer to the chiller manual for installation specifications.

    Type & Brand of Glycol Used*:

    By submitting below I hereby acknowledge that all items on this list have been completed in accordance with the chiller manual installation specifications and that I agree to the terms listed above. I also acknowledge that any delays in the startup not due to fault of the chiller, GDTS, or the local service representative of GDTS and their resulting cost are my responsibility.

    Please contact the GDTS Medical Service Team at 1‐800‐968‐5665 with any questions or concerns.

    Requested Date*:

    Site Manager*:


    Email Address*:


    Postal/Zip Code*:

    Company Name*:

    Site Name*:

    Site Address*:

    Chiller Serial #*:

    Chiller Model #*:


    Grant Consent*: