Title Page
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Project Number
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Conducted on
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Prepared by
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Address
Make of Solid Fuel Heater
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MAKE
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MODEL
CONDITION REPORT
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COMBUSTION HEATER/STOVE
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Item Replaced?
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FLUE INNER
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Item Replaced?
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COWL CHIMNEY COVER
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Item Replaced?
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ROOF FLASHING
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Item Replaced?
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FLUE OUTER
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Item Replaced?
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HEAT SHIELD
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Item Replaced?
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FIRE BOX
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Item Replaced?
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VENTS
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Item Replaced?
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BAFFLE
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Item Replaced?
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Item Replaced?
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DOOR & GLASS
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Item Replaced?
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HINGES, HANDLES AND SEALS
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Item Replaced?
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HEAT TILES/BRICKS
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Item Replaced?
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FIRE BRICKS
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Item Replaced?
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BRICKS & MORTAR
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Item Replaced?
Photos
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ANY OTHER RELEVANT PHOTOS