Title Page
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Location
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Date of Overhaul
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Name of Technician
Waterside & Fireside Cleaning
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Do you have the components needed to complete the cleaning
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What is the make and model of the boiler [provide a CLEAR picture of the rating plate]
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What components are needed in order to complete the overhaul?
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Did you replace the ignition rod? [provide before/after pics]
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Did you replace the flame rods? [provide before/after pics]
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Did you clean the combustion chamber? [provide before/after pics]
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Did you clean the water side of the boiler? [provide before/after pics]
Boiler Body and Piping
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Make and Model of Boiler [Take pics of rating plate]
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Are there leaks from the boiler body?
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Is the boiler jacket in good shape?
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Is the drain for the boiler working and clear of obstruction?
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Do any of the pipes in the boiler room look like they are on the verge of collapse due to lack of support?
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Is the flue/exaust piping in overall good shape and do they have clips to secure them together?
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Are any of the near-boiler pipes leaking or heavily corroded?
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Is the relief valve the correct one for the boiler?
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What's type of relief valve does it need to be replaced with? [provide pics and details]
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Are there any signs of leaks or corrosion from the relief valve?
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Did the relief valve pass a spring test?
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Does the relief valve have a blow down pipe that ends within 8" above grade?
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Is there a backflow on the feed line?
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Is the backflow free of leaks?
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Is there a spiral vent/air valve?
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Is it free of rust and leaks, and is it operational?
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Is the expansion tank properly supported?
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Is there a way to isolate and test the expansion tank?
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Is the pressure on the air side of the expansion tank equal to the pressure of the water in the boiler?
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Are all pumps free of leaks, oiled [if applicable] and operational? [if issues, provide specs for pump(s)]
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Are the pumps making circulation? [if issues, provide specs for pump(s)]
Boiler Controls
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Which safety controls does the boiler have?
- Primary LWCO
- Secondary LWCO
- Manual Reset Aquastat
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Is the LWCO free of leaks and rust?
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What's the make and model of the LWCO?
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Is the LWCO piped at the proper level?
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Is the aquastat set properly?
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Is there a temperature/pressure gauge on the boiler?
General Safety
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Is there a working emergency switch outside the boiler room?
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Is there a CO detector in the boiler room?
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Does the boiler CO detector work? [replace battery and test, if battery operated]
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Are there items stored in the boiler room that make it difficult to access the boiler?
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Is there a sump pump in the boiler room?
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Is the sump pump functioning?
System Controls
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Is there a working emergency switch by the boiler?
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What kind of system control is used to control the heating?
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Does thermostat work? [Replace batteries if battery-operated and test thereafter]
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Does thermostat work? [Replace batteries if battery-operated and test thereafter]
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Are the sensors communicating with the thermostat? [replace batteries if battery-operated]
Other Comments
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Please detail any other important details pertaining to the boiler
