Boiler Insp Form blank.pdf

BOILER INSPECTION

REPORT

TYPE OF INSPECTION

A INTERNAL AND EXTERNAL

C EXTERNAL UNDER OPERATION

DATE OF INSPECTION

BOILER PREPARED?

YES

NO

DATE OF LAST INSPECTION

DESCRIBE REPAIRS MADE SINCE LAST INSPECTION

IDENTIFICATION

INSTALLATION

MCALESTER ARMY AMMO PLANT

BUILDING NO.

DESCRIPTION OF BUILDING

MANNED

UNMANNED

BOILER NO.

TYPE (FT, WT, CI, etc.)

FT

NAT’L.BOARD NO.

MANUFACTURER SER.NO.

MFR.RATING

BOILER MANUFACTURER

YEAR BUILT

YEAR INSTALLED

MAX.ALLOW.WORK.PRES.

PSI

PRESSURE OBSERVED

STEAM

PSI WATER

BURNER MANUFACTURER

BURNER YEAR BUILT FUEL PRIMARY

FUEL SECONDARY

ECONOMIZER?

YES

NO

EXTERNAL / OPERATIONAL INSPECTION

WHAT WAS CHECKED? REMARKS

FLAME FAILURE

IGNITOR

PRIMARY LWCO

SECONDARY LWCO

LOW WATER ALARM

OPERATING PRESSURE

CUTOUT (STEAM)

HIGH PRESSURE CUTOUT

(STEAM)

OPERATING TEMPERATURE

CONTROL (HW)

HIGH TEMPERATURE

CUTOUT (HW)

OTHER _______________

DESCRIBE CONDITION OF BOILER SETTING, SUPPORTS, SEAMS, PIPE CONNECTIONS, ETC.;

LOCATION OF ANY CORROSION, LEAKAGE, OVERHEATING, OR SOOT. DESCRIBE CONDITION OF

PLANT & EQUIPMENT ASSOCIATED WITH THIS BOILER.

SAFETY / RELIEF VALVES

MANUFACTURER SIZE SET AT

(PSI)

CAPACITY

(LB/HR)

CONDITION AND HOW TESTED *

TOTAL CAPACITY OF SAFETY VALVES:

OTHER SAFETY DEVICES

PRESSURE

GAGE

CORRECTION TAKEN (IF NONE, GIVE REASON)

OTHER

APPLIANCES

WATER COLUMNS, GAGE GLASSES, GAGE COCKS, BLOW-DOWN PIPE & VALVES, DRIP PANS

REGULATORS

AND

CONTROLS

FEED WATER, COMBUSTION AIR DAMPER, FUEL TRAIN & VENTING

INSTALLATION BUILDING NO. BOILER NO.

INTERNAL INSPECTION

WHAT WAS CHECKED? REMARKS

DEPOSITS

(SCALE, GREASE, ETC.)

CORROSION, RUST, PITTING

CRACKS

SOOT

LEAKAGE

EVIDENCE OF OVERHEATING

OTHER _______________

BOILER ENTERED

DESCRIBE CONDITION AND LOCATION OF ANY SOOT, CORROSION, SCALE, OIL, EROSION,

GROOVING, BULGING, WARPING, OR CRACKING AND STATE IF ACTIVE OR INACTIVE. DESCRIBE

CONDITION OF SEAMS, REFRACTORY, BAFFLES, TUBES, TUBE ENDS, PIPE CONNECTIONS,

RIVETS, OR STAYS.

REMARKS AND RECOMMENDATIONS OF INSPECTOR

LIST DEFICIENCIES TO BE CORRECTED AND REPAIRS TO BE MADE (attach continuation sheet if necessary)

CONDITION OF BOILER

BOILER

FEATURE

CONDITION OF BOILER

FEATURE (check ONE box in each row)

BOILER

FEATURE

CONDITION OF BOILER FEATURE

(check ONE box in each row)

N O T

I N S P E C T E D

O R

N

T

A P P L I C A B L

F U L

Y

C C E P T A B

N

T

F U L

C E P T A B

T

I N S P E C T

N

P P L I C A B

F U L

C E P T A B

E

S

M

I N T E N A N

L E A N I N G

M I N O R

R E P A I

L I B R A T I O

E

S

P L A C E M E

M A J

P A I

BURNER SAFE-

TY SYSTEM

SOLID FUEL SYSTEM (FEED, GRATES, ASH)

BURNER IGNITION, OPERATION

SAFETY

VALVES

STEAM / HW PIPING & VALVES

BLOW-DOWN PIPING & VALVES

FUEL / VENT

PIPING

STEAM / HW PRESSURE GAGE

WETTED HEAT TRANSFER SURFACES

WATER LEVEL

SIGHT GLASS

FIRESIDE HEAT TRANSFER SURFACES

FURNACE REFRACTORY, BAFFLES

BOILER FOUNDATION, SUPPORT

OVERALL BOILER CONDITION BOILER SKIN, STACK

FEEDWATER SYSTEM, CONTROL

ELECTRIC BOX COVERS/WIRING

INSPECTOR

TYPE OR PRINT NAME OF INSPECTOR

SIGNATURE OF INSPECTOR DATE OF SIGNATURE

INSTALLATION REPRESENTATIVE

TYPE OR PRINT NAME OF REPRESENTATIVE

PHONE NUMBER DATE OF SIGNATURE

SIGNATURE OF REPRESENTATIVE ATTESTING THAT TYPE OF

INSPECTION LISTED (A OR C) WAS PERFORMED ON BOILER

LISTED, AND THAT INSPECTOR OFFERED THIS COMPLETED

REPORT FOR COPYING

*SIGNATURE OF REPRESENTATIVE WAIVING REQUIREMENT

FOR INSPECTOR TO LIFT SAFETY VALVES DURING

OPERATIONAL (C) INSPECTION