Boiler System Chemical Analysis

• Conducted on

  Date

• Prepared by

• Location
  Address

Instructions

• Monthly Boiler System Chemical Analysis:
  a) Apply all required PPE;
  b) Complete all questions;
  c) e-mail PDF report to supervisor
  d) Record actions in FAST PM

Boiler System Detail

• Building #:

• Boiler Name / Number / Status (Lead/Lag):

• Boiler Model #:

• Boiler Serial #:

Boiler System Assessment

• 1) Review boiler chemical feeder pot operational?

  Yes

  No

  N/A

• Boiler Chemical feeder pot need refilling?

  Yes

  No

  N/A

• Record amount of chemical used to refill pot.

• 3) Test pH of boiler drain water; results exceed 6.5 pH?

  Yes

  No

  N/A

• Record results of drain water test.

• 4) Check Domestic Hot Water Boiler salt tank operational?

  Yes

  No

  N/A

• 5) Is Domestic Hot Water Boiler salt tank on Honeywell equipment PM list?

  Yes

  No

  N/A

• If Domestic Hot Water Boiler salt tank is other vendor equipment, call CE dispatch, report service needed and record 'Jxxxx' work order #.

• Salt replenish required?

  Yes

  No

  N/A

• Record amount of salt used to replenish tank (i.e. one bag, half bag, quarter bag, etc.)

• Notes / Observations / Conditions as found.

• Inspector / Tester Signature:

  Sign

• Yes

  No

  N/A