Boiler Installation Inspection Checklist Form
Use this form to record the details, checks, and outcome of a boiler installation inspection.
Inspection Details
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspection Time
*
Hour Minutes
AM
PM
AM/PM Option
Site or Project Name
Property or Installation Address
*
Inspector Name
*
Installer / Contractor Name
Boiler and Installation Information
Boiler Manufacturer
*
Boiler Model or Type
*
Installation Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Fuel Type
*
Gas
Oil
Electric
Other
Installation Status
*
New Installation
Replacement
Upgrade
Other
Inspection Checklist and Outcome
Flue and ventilation check
*
Pass
Fail
Not Applicable
Gas or electrical connection check
*
Pass
Fail
Not Applicable
Pressure/leak check
*
Pass
Fail
Not Applicable
Controls and safety devices check
*
Pass
Fail
Not Applicable
Defects or corrective actions needed
Overall inspection result
*
Pass
Pass with notes
Fail
Submit
Should be Empty: