Goodfellow Boiler Inspection Form.rtf

GOODFELLOW AIR FORCE BASE

INSPECTION REPORT OF BOILER

(Make separate report for each boiler)

CITY AND STATE

BUILDING

DATE OF INSPECTION.

1. NUMBER OF BOILERS IN BUILDING SUBJECT TO INSPECTION

2. MANUFACTURED'S NAME

2A. MANUFACTURED'S MODEL NUMBER

2B. MANUFACTURED'S SERIAL NUMBER

3.TYPE OF BOILER STEAM

HOT WATER

WATER TUBE SCOTCH

PACKAGE TYPE C. I. SECTIONAL

FIRE TUBE H.R.T. FIRETUBE FIREBOX

OTHER (Specify type)

4. *TYPE OF SETTING

5. *DATE MANUFACTURED

5A. *DATE INSTALLED THIS LOCATION

6. *STATE SERVICE (Lighting, pumping, heating, power, etc.)

7. MAUNFACTURER’ RATING

CAPACITY (B.H.P., SQ. FT. STEAM OR H.W., E.D.R. OR LB/HR)

MAXIMUM ALLOWABLE WORKING PRESSURE LB/SQ. IN

7A. HOT WATER SUPPLY TEMPERATURE

7B. RETURN TEMPATURE

8. DATE OF LAST INS

PECTION

9. FUEL USED

COAL

OIL GAS

10. *NUMBER AND LENGTH OF TUBES

11. *DIAMETER OF TUBES (O.D.)

12. *MATERIAL AND GAUGE OF TUBES

13. GENERAL CONDITION OF SETTING

14. DOES BOILER CONTAIN GREASE?

YES NO

14A. DOES BOILER CONTAIN SCALE?

YES NO

15. IF SO, IS QUANTITY OF GREASE OR SCALE CONSIDERED SERIOUS?

YES NO

16. DO BOILER TUBES SHOW SIGNS OF BAGS OR BLISTERS?

YES NO

16A. IF SO, TO WHAT EXTENT OF EACH?

17. HAS BOILER BEEN RECEIVING FEED WATER TREATMENT?

YES NO

17A. IF SO, WHAT TYPE AND TO WHAT EXTENT?

18. CONDITION OF TUBES

19. ARE THERE ANY WARPED TUBES?

YES NO

20. *SAFETY VALVES

NUMBER TYPES SIZE

* To be recorded at first inspection only

21. CONDITION OF SAFETY VALVES

22. EACH SAFETY VALVE SET TO OPEN AT

LBS. WATER PRESSURE

23. WAS PRESSURE TEST MADE OF SAFETY VALVES?

YES NO

23A. RESULTS OF PRESSURE TEST, EACH VALVE OPEN

23B. RESULTS OF PRESSURE TEST, EACH VALVE CLOSED

24. WERE SAFETY VALVES RESET?

YES NO

24A. IF SO, FOR WHAT PRESSURE?

LBS./SQ. IN.

25. CONDITION OF BOILER GAUGE

26. WHAT VARIATION IN PRESSURE EXISTED BETWEEN PRESSURE VESSEL GAUGE AND INSPECTOR'S TEST GAUGE AT WORKING PRESSURE?

27. *SAFETY VALVES

NUMBER TYPES

SIZE

28. CONDITION OF SAFETY VALVES

29. EACH SAFETY VALVE SET TO OPEN AT

LBS. WATER PRESSURE

30. WAS PRESSURE TEST MADE OF SAFETY VALVES?

YES NO

30A. RESULTS OF PRESSURE TEST, EACH VALVE OPEN

30B. RESULTS OF PRESSURE TEST, EACH VALVE CLOSED

31. WERE SAFETY VALVES RESET?

YES NO

31A. IF SO, FOR WHAT PRESSURE?

LBS./SQ. IN.

32. CONDITION OF BOILER GAUGE

33. WHAT VARIATION IN PRESSURE EXISTED BETWEEN PRESSURE VESSEL GAUGE AND INSPECTOR'S TEST GAUGE AT WORKING PRESSURE?

34. WAS GAUGE CORRECTED?

YES NO

35. CONDITION OF GAUGE GLASS, WATER COLUMN AND TRY COCKS

36. CONDITION OF BLOW-OFF VALVES, AND LINE

37. GENERAL INTERNAL CONDITION OF BOILER

37A. GENERAL EXTERNAL CONDITION OF BOILER

38. IF OIL OR GAS IS USED FOR FUEL, DESCRIBE SAME: GIVE CONDITION, INCLUDING SAFETY CONTROLS

38A. FIRING EFFICIENCY

%CO2

38B. FLUE GAS TEMPERATURE

39. WHAT REPAIRS OR ALTERATIONS HAVE BEEN MADE SINCE LAST INSPECTION AND WHY WERE THEY MADE?

40. HAS ADEQUATE PROVISIONS BEEN MADE FOR FIRE FIGHTING?

41. IN YOUR OPINION IS THIS BOILER IN A SAFE CONDITION TO BE OPERATED?

YES NO

41A. IF ANSWER TO QUESTION 41 IS NO, THE INSPECTOR WILL NOTIFY THE CO/COR, IMMEDIATELY IN WRITING.

42. RECOMMENDATIONS AND REMARKS BY THE INSPECTOR (Include alterations, additions or repairs considered necessary) file_0.wmf

NOTE: Use additional sheets, if necessary, to supplement the above remarks

43. SIGNATURE OF INSPECTOR