Title Page

  • Inspection completed by

  • Inspection reference

  • Engineer Name

  • Vehicle Registration

  • Inspection Date

Equipment Inspection

Safety Equipment Inspection

  • PCB (flexi+ultra) 0020023825

  • PCB (hxi hx cxi cx sxi sx) 2000802731

  • PUMP (flexi + ultra) 0020014171

  • GLOW 0010032752 CABLE<br>

  • GAS VALVE (ultra) 2000802664

  • FAN (ultra) 0020037309

  • FLOW SENSOR KIT (cx cxi) 0020014174

  • PRESURE SENSOR (glowworm vailant) S5720500

  • THERMISTOR (hxi hx cxi cx sxi sx) 801722

  • SIPHON ADAPTOR 20057359

  • SIPHON KIT (ultra) 0020013711

  • DIVERTER VALVE (flexi + ultra) 0020014168

  • 3 WAY DIVERTER CARTRIDGE (si cxi cx) s1006400

  • AAV (brass) s1005600

  • AAV (plastic GW Vailant) 0020014161 / 104521

  • PRV 3bar 0020014173

  • ELECTRODE KIT (ultra cxi sxi hxi) 0020152565

  • ZIG IGNITOR 801655

  • FILLING LOOP (cxi ci) 2000802600

  • FILLING LOOP (flexi + ultra) 0020026414

  • MECHANICAL TIMER 2000800089

  • 0010032752 GLOW WORM LEAD

  • ELECTRODE KIT (sustain) 0020246709

  • FAN 0020135138

  • DIVERTER VALVE (sustain)

  • FAN 0020135138

  • PCB (sustain) 0010047389

  • PUMP (sustain) 0020231141

  • AAV (all models) 0010033857

  • PRV 87161064310

  • AAV 87161064450

  • SIPHON (b4 jun 08) 87161066100

  • SIPHON (aft jun 08) 87161138370

  • Presure Gauge 87161164280

  • FLOW ADAPTOR 87161064330

  • FLOW SENSOR Z87161157540

  • DHW SENSOR 87145000810

  • CHARGING LINK 87161045920

  • DIVERTER MOTOR 7216534

  • DIVERTER CARTIDGE Z7656807

  • HALL EFFECT SENSOR 5114767

  • NTC SENSOR 5114725

Universal

  • GRUNDFOS UPS3 15-50/65

  • HONEYWELL HOME T3 Wired T3H110A0066

  • HONEYWELL HOME T4 Wired T4H110A0021

  • Honeywell Home T3R Wireless Programmable Thermostat White Y3H710RF0053

  • BANICO 3 Port Valve 22mm Comp ZVM22

  • BANICO 2 Port Valve 22mm Comp ZV22

  • PLUMBRIGHT Standard Filling Loop

  • Replacement Synchronous Motor

  • HONEYWELL HOME Room Stat T6360B1028

Service kit

  • Worcester 87161105340 Burner Seal x 5

  • Vaillant G10 seal x 4

  • Flue Clamps 100mm x 4

  • Glow-worm Heat Exchanger Door Seal Black 801635

  • H/Well ,id position valve

  • Honeywell 2 port

  • Worcester Auto air vent

  • Employee Signature

  • Assessor Signature

  • Next Check Due

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.