Boiler Inspection Form.pdf

BUREAU OF PRISONS

BOILER INSPECTION

REPORT

TYPE OF INSPECTION:

A INTERNAL AND EXTERNAL

B INTERNAL AND EXTERNAL WITH HYDROSTATIC TEST

C EXTERNAL WHILE OPERATIONAL

D EXTERNAL INSPECTION WITH HYDROSTATIC TEST

E INTERNAL AND EXTERNAL OF OTHER PRESSURE

VESSEL

DATE OF INSPECTION

INSPECTION NUMBER

CONTRACT NUMBER

SECTION I - IDENTIFICATION

INSTITUTION Type of Service(Steam Heat/Dom HW/Heat loop) BUILDING

BOILER TYPE (Fire Tube/Water Tube) MODEL BOILER # (Per BOP ITMS System) MANUFACTURER’S RATING (HP)

MANUFACTURED BY YEAR BUILT YEAR INSTALLED FUEL

DESIGN WORKING PRESSURE PRESSURE ALLOWED SAFETY VALVE SETTING PRESSURE OBSERVED

STEAM HYDROSTATIC Lbs.

SECTION II - STATEMENT FROM OPERATOR

REPAIRS MADE SINCE PREVIOUS INSPECTION

SECTION III - INTERNAL INSPECTION (Types A, B & E only)

DESCRIBE INSPECTION FULLY (State location of any scale, grease oil or other deposits; any corrosion, pitting, grooving, cracks or de-laminations; any evidence of overheating, such as bulging, or warping; any broken or loose rivets or stays, etc.)

SECTION IV - EXTERNAL INSPECTION

CONDITION OF SEAMS, TUBE ENDS, PIPE CONNECTIONS, ETC. (Describe fully and state the location of any corrosion, leakage, erosion, evidence of overheating, soot or other destructive accumulations, etc.)

Sample of Potential Required Report

SECTION V - INSPECTION OF SAFETY DEVICES

SAFETY

VALVES

SIZE (No. & diameter)

SET AT (Lbs)

CONDITION AND HOW TESTED

PRESSURE GAGE

STATE CORRECTION, IF MADE. STATE REASON, IF NOT TESTED.

OTHER

APPLIANCES

WATER COLUMNS, GAGE GLASSES, GAGE COCKS, BLOW OFF AND VALVE OR COCKS, FEED PIPE., ETC.

REGULATORS

AND CONTROLS

FEED WATER, DAMPER, COMBUSTION, ETC.

SECTION VI - STATEMENT OF INSPECTOR

WAS BOILER PREPARED FOR THROUGH EXAMINATION? (If not, explain why in Section VII,)

YES

NO

WAS BOILER ENTERED FOR INSPECTION? (If not, explain why in Section VII,)

YES

NO

SECTION VII - REMARKS AND RECOMMENDATIONS OF INSPECTOR

LIST DEFICIENCIES TO BE CORRECTED AND REPAIRS TO BE MADE. (Use supplemental sheet, if necessary)

TYPED NAME AND TITLE OF INSPECTOR

SIGNATURE OF INSPECTOR

SECTION VIII - ACTION TAKEN ON RECOMMENDATIONS

TYPED NAME AND TITLE OF CONTRACT ADMINISTRATOR

SIGNATURE OF CONTRACT ADMINISTRATOR