C&O Sales Start-Up Request Form

Lighting Controls Start-Up Request Form
Job Name*
Project # / PO # (if available)
Can be located on the Submittal or Purchase Order
Site Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Controls Manufacturer*
THREE WEEKS NOTICE IS REQUIRED FOR STARTUP SCHEDULING.
By completing this form, you are requesting a startup visit for the above-referenced project. All checklist items listed below have been, or will be, completed prior to the startup date. Additional visits or extended startup time required as a result of site readiness deficiencies will result in additional charges.

If needed, call to reschedule prior to 72 business hours. (Office: 913-981-0008)

Site Readiness Checklist*

Rows	Complete/Yes	Not Complete/No	N/A
Verify Cat-5e/Cat-6 cable used throughout entire project when applicable.
CONFIRM: RJ45 PASS-THRU CONNECTORS ARE NOT USED. THESE ARE NOT PERMITTED BY OUR MANUFACTURERS, REPLACE ALL IF USED.
Point-to-point continuity test complete on each RJ45 termination
Control devices/keypads properly installed and wiring complete. This includes occupancy/vacancy sensors:
Panel(s) properly installed and wiring complete
Permanent Power Available
Device network addresses set and verified no duplicate addresses (if applicable)
Unobstructed access to control components provided
If applicable, device(s) are connected to building LAN - If this functionality is required and not available, please indicate in comments.
BMS/BACnet integrator contact information provided. If yes, please indicate in the comments.
UL924 or UL1008 devices are installed appropriately
I am not missing any material nor is any material defective (if material falls under these categories, please indicate in the comments)
Is Owner Training Required? If yes, please indicate requested date in below.
LEVITON ONLY: End of Line Terminators Installed

Comments or Additional Information
SITE/SYSTEM READINESS FOR FINAL CHECKOUT:
- The contractor must have completed system installation prior to the Field Technician’s arrival in order for commissioning, training and sign-off to be completed.
- If this is not the case, the Field Technician may be required to return on another date at the expense of the contractor.
- Please do not attempt to energize or otherwise operate the equipment before inspection is made, as this may damage the equipment severely and automatically void the warranty. Consult the C&O Sales for details.

COMMISSIONING, TRAINING, AND SIGNOFF:
- Unless otherwise specified at time of purchase, only one trip by a Field Technician will be made to the job site for system commissioning.
- It is important that all representatives of such parties as the owner, purchaser, installing contractor, and consultant be present at system checkout to countersign the inspection records.
- C&O can assume no responsibility for the time of the Field Technician(s)
- Please take into consideration the availability of these persons prior to scheduling the commissioning visit. After system checkout is completed, a representative(s) of the owner must be available to receive operation and maintenance instruction (if applicable).
THREE WEEKS NOTICE IS REQUIRED FOR STARTUP SCHEDULING.
Requested Date for Start-Up*

MonthDayYear
Date
Requested Date for Owner Training

MonthDayYear
Date
Expedited Startup

Call to discuss after submission (Office: 913-981-0008)
Standard Request (3 weeks or more)Expedited Request (Revised PO or Secondary PO for Expedited Startup is Required)
Contact Information
Contractor Name (Site Contact)*

First NameLast Name
Site Contact Phone Number *
Please enter a valid phone number.Format: (000) 000-0000.
Site Contact Email*
example@example.com
Project Manager Name

First NameLast Name
Project Manager Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Project Manager Email
example@example.com
Contractor Signature*
Name of Signer*

First NameLast Name
Should be Empty:

Lighting Controls Start-Up Request Form

THREE WEEKS NOTICE IS REQUIRED FOR STARTUP SCHEDULING.

THREE WEEKS NOTICE IS REQUIRED FOR STARTUP SCHEDULING.

Expedited Startup

Contact Information