Boiler Inspection Checklist

• Inspection Date and Time

  Date

• Prepared by

• Location

Internal Inspection

• Manufacturer

• Model Number

• Serial Number

• Year Of Manufacture

• Burner Nozzle

  Safe

  At Risk

  N/A

• Stack Flue

  Good

  Fair

  Poor

  N/A

• Insulation

  Good

  Fair

  Poor

  N/A

• External Fabric Works

  Yes

  No

  N/A

External Inspection

• Safety Relief Valve

  Good

  Fair

  Poor

  N/A

• Pressure Gage

  Good

  Fair

  Poor

  N/A

• Review Record Logs (weekly, monthly, yearly)

  Compliant

  Non-Compliant

  N/A

Operational

• Boilers:

  Gas Fired

  Electric

• • Start in low Fire

  Safe

  At Risk

  N/A

• • Low Gas Pressure

  Safe

  At Risk

  N/A

• • Burner Draw Switch (if applicable)

  Safe

  At Risk

  N/A

• • Flame Sensor

  Safe

  At Risk

  N/A

• • Expansion Vessel

  Good

  Fair

  Poor

  N/A

• • Normal Trip

  Compliant

  Non-Compliant

  N/A

• • Test Relief Valve under Pressure

  Compliant

  Non-Compliant

  N/A

Completion

• Comments

• Inspector: Name and Signature

  Sign