Title Page

  • Conducted on

  • Prepared by

  • Location

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?

  • Boiler Chemical feeder pot need refilling?

  • Record amount of chemical used to refill pot.

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

  • Record results of drain water test.

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

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

  • 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?

  • 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:

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