Title Page
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Address of Boiler
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GPS location stamp
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Customer Name
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Conducted on
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Prepared by
Boiler Room Entrance
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Does boiler room have a sign on it
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Is there an emergency shutoff switch outside of the boiler room
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Is there a fire extinguisher outside of the boiler room?
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Does the door open towards egress?
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Is the boiler room door self-closing and latching?
Boiler Room
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What floor is the boiler room located on?
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Specify Floor
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Is there adequate lighting in the boiler room?
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Are there any defective or exposed wires in the boiler room?
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Is the boiler room free of debris and hazardous material?
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Are there any holes in the ceiling, walls or around the door frame or windows?
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Is the boiler room required to have a second means of egress?
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Is there a second door and is the 2nd door code-compliant?
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Does the room have a second means of egress?
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Is there an emergency switch outside the door?
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Is there a boiler room sign on the door
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Is there a door in the boiler room that does not lead to egress?
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Does the door have a "Not an Exit" sign on it?
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What type of fresh air does the boiler room have?
- Louver
- Fan
- Fire Duct
- Wall Duct
- Other-Code-Compliant
- Other-Non-Code-Compliant
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Is the louver code compliant?
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Are the dimensions of the louver fitting for the BTU's of all the burning equipment in the room?
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What are the dimensions of the fresh air?
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Is there a proving switch for the fan?
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Does the fan match the plans/application?
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Are there any other code-compliance issues relating to the fan that need to be addressed?
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Is the wall duct going through rooms?
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Does the duct have a form of fire-rating or have a fire damper on it?
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Does the duct terminate outside the building by at least 30" above grade?
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Are there any other code-compliance issues with the wall duct?
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Please specify what is not compliant
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Is the duct terminating with the outside air and at least 30" above grade?
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Are there any other code-compliance issues with the wall duct?
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Is the duct adequately supported
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What type of other code-compliant fresh air does the boiler room have?
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Does the chimney have a clean out?
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Is the cleanout a min of 8"?
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Is breaching in generally good condition?
Boiler/Heating Equipment
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How many water heaters are in the boiler room?
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What is the rating make and model for the water heater(s)? (Provide picture)
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Is there a water heater rated as a boiler (H) or over 350K BTU's?
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Does the water heater have a manual reset aquastat?
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Does the water heater have a manual reset LWCO?
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Does the water heater have a spill switch on the hood?
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Are the controls on the water heater isolatable?
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Is there a labeled emergency shutoff switch at the hot water heater?
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Is there a HW storage tank in the boiler room?
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What is the rating make and model of the HW storage tank? (provide picture)
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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?
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How many boilers are in the boiler room?
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Are the boilers the same make and model?
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What is the make and model of the 2nd boiler and burner? (provide pics of rating plate)
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What is the make and model of the boiler and burner? (provide pics of rating plate)
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What is the BTU of the boiler?
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Is the boiler steam or hydronic?
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Does the boiler have 2 LWCO's?
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Is one of the LWCO's manual reset?
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Are there 2 pressuretrols?
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Are one of the pressuretrols manual reset?
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Is there a pressure gauge on the boiler?
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Are there brass pigtails for all of the controls?
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Are any of the operating controls isolateable with a valve?
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Is the control manifold piped in a code-compliant manner?
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What is wrong with the control manifold?
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Is there a check valve where the feed goes into the return line?
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Does the boiler have 2 LWCO's?
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Does the secondary LWCO have a manual reset?
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Does the boiler have 2 aqua stats?
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Is one of the aqua stats manual reset?
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Are any of the operating controls isolated by a valve?
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Does the boiler have a fire sight glass that is in good condition?
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Does the boiler have a relief valve?
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Does the boiler relief rating match the rating of the boiler? (take picture of relief valve rating)
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Does the boiler have a coil?
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Does the coil have a domestic relief?
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Is the relief isolated from the coil?
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Does the feed water line have a backflow?
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Is the backflow free of leaks?
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Are the relief valves blow downs copper or black?
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Are there threads at the end?
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Are the relief valve blow downs within 8" of the grade?
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Are the backflow blow downs copper?
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Are the backflow blow downs within 8" of the grade?
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What type of LWCO is it?
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Are the LWCO's blow downs copper?
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Are the LWCO's blow downs within 8" of the grade?
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Is the boiler jacket in good condition?
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Are there any leaking or corroded pipes in the boiler room?
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Are all the near-boiler piping insulated?
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Are the gas/oil pipes adequately supported?
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What is the size and material of the piping?
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How many supports are needed per pipe?
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What kind of supports are needed?
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Are the steam pipes and domestic water pipes adequately supported?
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What is the size and material of the piping?
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How many supports are needed per pipe?
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What kind of supports are needed?
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Are there any pipes in the boiler room supported by another pipe?
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What is the size and material of the piping?
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How many supports are needed per pipe?
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What kind of supports are needed?
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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]
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Does the flue pipe require a damper?
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Is there a damper on the flue pipe?
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Does the damper have a spill switch above it?
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Are the red stoppers in the vent/damper?
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Is there a spill switch at the vent hood?
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Is the flue pipe adequately supported (at least one support if the run is very short)?
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What is the size of the flue pipe?
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How many supports are needed per pipe?
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What is the fuel type for the heating equipment?
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Does the burner have a sand pail with sand next to it?
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Is there a fire omatic valve installed?
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Does the tank room have adequate lighting?
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Is the tank room clean?
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Is the size of the oil tank listed and labeled?
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Does oil tank have a tag stating what type of oil is inside of it?
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Does the oil tank have a working gauge?
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Is the oil tank secured to the ground?
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Is there fresh air in the oil tank room?
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Is there 2 oil symbol outside the building?
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Is total capacity of oil 660 gallons or more?
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Is there spill containment around the tanks?
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Other notes/comments