Title Page

  • Address of Boiler

  • GPS location stamp
  • Customer Name

  • Conducted on

  • Prepared by

Boiler Room Entrance

  • Does boiler room have a sign on it

  • Is there an emergency shutoff switch outside of the boiler room

  • Is there a fire extinguisher outside of the boiler room?

  • Does the door open towards egress?

  • Is the boiler room door self-closing and latching?

Boiler Room

  • What floor is the boiler room located on?

  • Specify Floor

  • Is there adequate lighting in the boiler room?

  • Are there any defective or exposed wires in the boiler room?

  • Is the boiler room free of debris and hazardous material?

  • Is there any place within boiler room or within close proximity to boiler that can be used to dispose of liquid?

  • By what means is the liquid being disposed?

  • Is sump pump installation code-compliant?

  • What is wrong with the sump pump?

  • Does the sump pump have a cover?

  • Is sink installation code-compliant?

  • Is installation code-compliant?

  • Is the boiler in a pit?

  • Are there any holes in the ceiling, walls or around the door frame or windows?

  • Is the boiler room required to have a second means of egress?

  • Is there a second door and is the 2nd door code-compliant?

  • Does the room have a second means of egress?

  • Is there an emergency switch outside the door?

  • Is there a boiler room sign on the door

  • Is there a door in the boiler room that does not lead to egress?

  • Does the door have a "Not an Exit" sign on it?

  • What type of fresh air does the boiler room have?

  • Is the louver code compliant?

  • Are the dimensions of the louver fitting for the BTU's of all the burning equipment in the room?

  • What are the dimensions of the fresh air?

  • Is there a proving switch for the fan?

  • Does the fan match the plans/application?

  • Are there any other code-compliance issues relating to the fan that need to be addressed?

  • Is the wall duct going through rooms?

  • Does the duct have a form of fire-rating or have a fire damper on it?

  • Does the duct terminate outside the building by at least 30" above grade?

  • Are there any other code-compliance issues with the wall duct?

  • Please specify what is not compliant

  • Is the duct terminating with the outside air and at least 30" above grade?

  • Are there any other code-compliance issues with the wall duct?

  • Is the duct adequately supported

  • What type of other code-compliant fresh air does the boiler room have?

  • Does the chimney have a clean out?

  • Is the cleanout a min of 8"?

  • Is breaching in generally good condition?

  • Does the chimney require a cap?

  • Does the chimney have a cap?

  • Is there a cap on the chimney

Boiler/Heating Equipment

  • How many water heaters are in the boiler room?

  • What is the rating make and model for the water heater(s)? (Provide picture)

  • Is there a water heater rated as a boiler (H) or over 350K BTU's?

  • Does the water heater have a manual reset aquastat?

  • Does the water heater have a manual reset LWCO?

  • Does the water heater have a spill switch on the hood?

  • Are the controls on the water heater isolatable?

  • Is there a labeled emergency shutoff switch at the hot water heater?

  • Is there a HW storage tank in the boiler room?

  • What is the rating make and model of the HW storage tank? (provide picture)

  • Does the water storage tank have a T&P relief valve that is positioned correctly and has a copper blow-down pipe that is a max of 8" above grade?

  • How many boilers are in the boiler room?

  • Are the boilers the same make and model?

  • What is the make and model of the 2nd boiler and burner? (provide pics of rating plate)

  • What is the make and model of the boiler and burner? (provide pics of rating plate)

  • What is the BTU of the boiler?

  • Is the boiler steam or hydronic?

  • Does the boiler have 2 LWCO's?

  • Is one of the LWCO's manual reset?

  • Are there 2 pressuretrols?

  • Are one of the pressuretrols manual reset?

  • Is there a pressure gauge on the boiler?

  • Are there brass pigtails for all of the controls?

  • Are any of the operating controls isolateable with a valve?

  • Is the control manifold piped in a code-compliant manner?

  • What is wrong with the control manifold?

  • Is there a check valve where the feed goes into the return line?

  • Does the boiler have 2 LWCO's?

  • Does the secondary LWCO have a manual reset?

  • Does the boiler have 2 aqua stats?

  • Is one of the aqua stats manual reset?

  • Are any of the operating controls isolated by a valve?

  • Does the boiler have a fire sight glass that is in good condition?

  • Does the boiler have a relief valve?

  • Does the boiler relief rating match the rating of the boiler? (take picture of relief valve rating)

  • Does the boiler have a coil?

  • Does the coil have a domestic relief?

  • Is the relief isolated from the coil?

  • Does the feed water line have a backflow?

  • Is the backflow free of leaks?

  • Are the relief valves blow downs copper or black?

  • Are there threads at the end?

  • Are the relief valve blow downs within 8" of the grade?

  • Are the backflow blow downs copper?

  • Are the backflow blow downs within 8" of the grade?

  • What type of LWCO is it?

  • Are the LWCO's blow downs copper?

  • Are the LWCO's blow downs within 8" of the grade?

  • Is the boiler jacket in good condition?

  • Are there any leaking or corroded pipes in the boiler room?

  • Are all the near-boiler piping insulated?

  • Are the gas/oil pipes adequately supported?

  • What is the size and material of the piping?

  • How many supports are needed per pipe?

  • What kind of supports are needed?

  • Are the steam pipes and domestic water pipes adequately supported?

  • What is the size and material of the piping?

  • How many supports are needed per pipe?

  • What kind of supports are needed?

  • Are there any pipes in the boiler room supported by another pipe?

  • What is the size and material of the piping?

  • How many supports are needed per pipe?

  • What kind of supports are needed?

  • Is the flue pipe the correct gauge for the size installed? [up to 5": 26], [6"-10": 24], [11"-16": 22], [17" and above: 16]

  • Does the flue pipe require a damper?

  • Is there a damper on the flue pipe?

  • Does the damper have a spill switch above it?

  • Are the red stoppers in the vent/damper?

  • Is there a spill switch at the vent hood?

  • Is the flue pipe adequately supported (at least one support if the run is very short)?

  • What is the size of the flue pipe?

  • How many supports are needed per pipe?

  • What is the fuel type for the heating equipment?

  • Does the burner have a sand pail with sand next to it?

  • Is there a fire omatic valve installed?

  • Does the tank room have adequate lighting?

  • Is the tank room clean?

  • Is the size of the oil tank listed and labeled?

  • Does oil tank have a tag stating what type of oil is inside of it?

  • Does the oil tank have a working gauge?

  • Is the oil tank secured to the ground?

  • Is there fresh air in the oil tank room?

  • Is there 2 oil symbol outside the building?

  • Is total capacity of oil 660 gallons or more?

  • Is there spill containment around the tanks?

  • Other notes/comments

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