EMCOR Betlem Boiler Form

• This Document is Being Prepared by (name):

• Customer/Client Name & WO/Job Number

• Date Work Performed

  Date
• Location
  Address

All calls, regardless of the nature, require that all safety controls should be tested while burner is firing to insure proper operation. Once you have completed this form you must send it to the Service Manager (Mark Bertolani).

Boiler Information

• Make

• Model

• Serial Number

• Input

• Working Pressure

Documentation of the following information is required on ALL SERVICE CALLS.

• Check operating temperatures/water boilers

• Supply

• Return

• Comments

• Check for proper ignition and condition of flame.

• Comments

• Check water pressure/ water boilers

• PSIG

• Comments

• Check for water leaks

• Comments

• Check expansion tank and water make up

• Comments

• Check for gas or oil leaks

• Comments

• Check flue pipe

• Comments

• Check draft regulator

• Comments

• Check draft inducer -if used

• Comments

• Inspect combustion side

• Comments

• Inspect ignitor or pilot assembly

• Comments

• Check ignition wire/ insulator

• Comments

• Check blower wheel -combustion air

• Comments

• Check combustion air dampers and/or linkage

• Comments

• Test flame safety control

• Comments

• Test pressure relief/ low pressure boilers ONLY

• Comments

• Check and TEST operating and safety controls

• Comments

• Check for proper fuel shut off

• Comments

• Inspect oil filter/ check pressure

• Comments

• Blow down all safety and operation controls

• Comments

Required Signatures

• The technician signing this form is the technician who prepared this form. All information is accurate.

  Sign

• Customer Signature

  Sign