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Refrigerant Leak Reporting Form

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– Step 1 of 5

Use this form to report a refrigerant leak. This is mandatory for new equipment or for labor and/or material concession requests. A minimum of 1 video and 1 photo is required and MUST SHOW BUBBLES.

ELECTRONIC LEAK DETECTOR OR PICTURES OF OIL STAINS IS NOT ACCEPTABLE!!!

Please watch each of these videos prior to proceeding.

Did you watch both videos?

Yes
No

Do you understand that you must show bubbles in the pictures and videos and that an electronic leak detector is NOT ACCEPTABLE?

Yes
No

Information

ELECTRONIC LEAK DETECTOR OR PICTURES OF OIL STAINS IS NOT ACCEPTABLE!!!

If working with a Customer Assurance Manager please select below. If not select none.

Are you at the jobsite now? *

Yes
No

Save and Resume Later

Dealer Information

ELECTRONIC LEAK DETECTOR OR PICTURES OF OIL STAINS IS NOT ACCEPTABLE!!!

Dealer Name *

Dealer Account Number *

Job Name *

Name *

First

Last

Technician's Phone Number

Email *

Service Manager's Email *

Service Manager's Phone # *

Save and Resume Later

Product Information

Application *

Residential
Light Commercial – Office/Retail
Heavy Commercial – Manufacturing/Warehouse
Industrial – Heavy Manufacturing/Printing/Chemical/Other

Equipment Type *

Split System
RTU / Package unit
WSHP / Geothermal
Ductless
VRF

Is the leak in a coil?

Yes
No

Coil Type *

Evaporator
Condenser
Reheat
Coaxial Heat Exchanger

Coil Design/Material *

RTPF – Copper ….. Copper tube/aluminum fin
FTPF – Aluminum ….. Aluminum tube/aluminum fin
MCHX ….. Micro-channel heat exchanger
Cupro-Nickel coaxial heat exchanger
Copper coaxial heat exchanger

Coil Coating *

No Coating
Factory coating
Third party coating

Location – Any environmental concerns? *

Yes
No

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Equipment Information

Model Number *

Serial Number *

Installation / Start-up Date *

Is this a DOA Leak? *

Yes
No

Found less than 30 days from startup?

Is the equipment operational now? *

Yes
No

Equipment information/history

Provide any pertinent history for this unit. Repairs, failures, issues, etc.

Answer each question about this leak

Was a leak test performed? *

Yes
No

Was the leak identified? (Pictures required with bubbles) *

Yes
No

Is the leak repairable? *

Yes
No

Leak Type *

Solder Joint
Puncture
Tube failure/crack

Leak Location

Leak Location *

U-bend
In fin pack
At tube sheet
Distributor / header
Factory piping
Coaxial heat exchanger
Compressor Shell
BPHX (Braze plate heat exchanger)

Leak's possible cause? *

Operating vibration
Operating rub (metal, tubes, wires, etc)
At tube sheet
Manufacturing workmanship
Environmental corrosion
Shipping

Description of the leak and its location. *

Description should be a compliment to videos and/or photos required to be submitted to TS following this form.

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VIDEOS & PHOTOS

SUBMITTING VIDEOS/PHOTOS

In one or more videos, you should first show the general location of the leak within the unit, followed by a closer look at the leak using liquid leak detector or soap bubbles. The videos can be made with your mobile device’s camera or uploaded from its memory.

Leak Videos/pictures (add up to 4 files) *

Click or drag files to this area to upload. You can upload up to 4 files.

Thank you for your assistance reporting the refrigerant leak!!!

What is being requested?

Labor/material assistance for repairing a repairable leak
Approve a Replacement Unit

Once the CAM Team/Technical Support has had an opportunity to evaluate the supplied information we will reach out to you with next steps.

Save and Resume Later

Your form entry has been saved and a unique link has been created which you can access to resume this form.

Enter your email address to receive the link via email. Alternately, you can copy and save the link below.

Please note, this link should not be shared and will expire in 30 days, afterwards your form entry will be deleted.

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Email *

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