Medical Buildings and Hospitals—Systems to Commission

Chapter 1
Project: _____________________________________________ Address: _________________________________
Owner: _____________________________________________ Email/Phone: ______________________________
Owner’s Project Manager: ______________________________ Email/Phone: ______________________________
Cx Provider: _________________________________________ Email/Phone: ______________________________
Date Initiated: ______________________ Date Revised: ______________________
System Integrated System

Chapter 2
Commissioning
Commissioning Commissioning
Item Equipment/System Completed—
Required— Required—
Date
Y/N Y/N
1. Air-conditioning and ventilation systems
2. Domestic hot-water systems

Chapter 3
3. Plumbing systems
4. Lighting and control systems
5. Electrical power systems
6. Energy monitoring and management systems

Chapter 4
7. Outdoor air and energy recovery systems
8. Landscape irrigation systems
9. Fire protection and fire sprinkler systems
10. Fire alarm systems
11. Vertical transportation (elevators, escalators)
12. Building enclosures
13. Computer rooms and data systems
14. Security systems

Appendix A
15. Telephone and communication systems
16. Medical gas systems
17. Steam systems
18. Central plant and connected systems
19. Humidification systems

Appendix B
20. Nurse call systems
21. Renewable energy systems
22. Room pressurization
The approval section that follows can be used if applicable to the planning process. Appendix B
I have reviewed the required items and plans and verified that they meet the project requirements:
Owner or Owner’s Representative Name: ____________________________________________________________
Company Name: _______________________________________________________________________________
Signature: _____________________________________________ Date: __________________________________

Revision:
Appendix B

Owner or Owner’s Representative Name: ____________________________________________________________

Company Name: _______________________________________________________________________________
Signature: _____________________________________________ Date: __________________________________