Thermostatic Mixing Valve Commissioning/Test Report - duplicate

• THERMOSTATIC MIXING VALVE COMMISSIONING/TEST REPORT

• Document No.

• Site Name

• Site Location
  Address

• Site Contact Name

• Site Contact Number

• Conducted on

  Date

• Prepared by

Make of TMV

• Model No.

• Serial Number

• Valve Type

• Valve Location

Number of Fixtures Serviced by This Valve

• Basins

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  • 10

• Showers

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  • 1
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  • 4
  • 5
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  • 9
  • 10

• Baths

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  • 1
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  • 6
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  • 10

• Other (note details below)

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  • 10

• Description of other items

Work Carried Out This Visit

• Dismantled

• Thermostat Element Replaced

• Serviced

• O Ring Replaced

• Thermal Shut Down Function

• Components Inspected and Cleaned

• Commissioned

• Non Return Valves Checked

• Temperature Set

Thermal Shutdown Test

• Temperature of Water Supply - Before test

• Temperature of Water Supply - After Reset

• Dynamic Pressure of Water Supply - HOT (KPA)

• Select from range

• Dynamic Pressure of Water Supply - COLD (KPA)

• Select from range

• Temperature of TMV at Outlet - (Degrees)

• Select from range

Install/Service Information

• Date of Installation

  Date

• Date of Commissioning

  Date

• Date of Service

  Date

• Next Service Date

  Date

• Valve Installed By

• Valve Commissioned By

• Valve Serviced By

• Additional information

Licensee Details

• Licensee Signature

  Sign

• Licence No.

Client Acknowledgement

• Name of Client

• Signature of Client Representative

  Sign

• Name of Client Representative

• Date/Time

  Date