Title Page

  • Inspection Date and Time

  • Prepared by

  • Location
  • Boiler Name

  • Boiler Function

Boiler Inspection

Internal Inspection

  • Combustion Chamber

  • Brick Work

  • Insulation

  • Fire Water Tubes

  • Burner Nozzle

  • Steam Drum

  • Stack Flue

  • Blow off Valve

External Inspection

  • Programmer

  • Identify Programmer

  • Safety Relief Valve

  • Low Water Fuel Cutouts

  • Water Column

  • Pressure Gage

  • Review Record Logs (weekly, monthly)

  • Condensing Neutralizer Installed

  • Hydrostatic Test

  • Backflow Preventer

  • Date of last Combustion Tuning

  • Date of last waterside inspection

  • Date of last 150% Strength Hydro

Operational

  • Gas Boilers:

  • • Start in low Fire

  • • Loss of Combustion Air

  • • Low Gas Pressure

  • • High Gas Pressure

  • Fuel Oil Boilers:

  • • Start in Low Fire

  • • Loss of Combustion Air

  • • Loss of Atomizing Air

  • • Low Oil Pressure

  • • Burner Draw Switch (if applicable)

  • • Proximity Switch (if applicable)

  • All Boilers:

  • • Flame Sensor

  • • LWCO (left Right)

  • • Feed Pump Recirculating Pump

  • • Normal Trip

  • • Flame Pattern Inspection

  • • Water Treatment

  • • High Trip

  • • Emergency Stop

  • • Combustion Tuning

  • • Combustion (Air Fuel) Control System

  • • Test Relief Valve under Pressure

Boiler Efficiency

  • Boiler is:

  • Oxygen %

  • CO ppm

  • CO2%

  • SO2 ppm

  • NO ppm

  • Stack Temp.

  • Safety/Relief Valve:

  • Manufacturer

  • Size

  • PSI

  • BTU/Hr

  • Gage:

  • Manufacturer

  • PSI

Completion

  • Comments

  • Inspector: Name and Signature

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