Specialty Compliance Services
Boiler Program
PO Box 44410
Olympia WA 98504-4410 / Inservice Inspection
Checklist
Inspector’s Name / Location Name / Contact Name / Date
Boiler Inspection
Power Boilers (Steam Heating, Small Power, Power Steam)
State Number(s):
1. / External Inspection at / PSI / 6. / Low Water Cut Off with Manual Reset Tested
2. / Low Water Cut Off Tested / 7. / High Pressure Control with Manual Reset
3. / High Pressure Control / 8. / Pressure Gage
4. / Relief Valve Tested / 9. / Gas Train Recognized Standard
5. / Internal Inspection
Remark:
Low Pressure Boilers (HW Supply, LP Heating, Power HW)
State Number(s):
1. / High Temperature Limit / 5. / High Temperature with Manual Reset
2. / Low Water Cut Off with Manual
Reset Tested / 6. / Coil Type – Flow Switch
3. / Temperature Gage / 7. / Pressure Gage
4. / Relief Valve Tested / 8. / Gas Train Recognized Standard
Remark:
Pressure Vessel Inspection
Pressure Vessels
State Number(s):
1. / External Inspection / 4. / Internal Inspection
2. / Drain / 5. / Pressure Gage
3. / Safety Valve Tested / 6. / U.T. Inspection
Remark:
Hot Water Heaters
State Number(s):
1. / External Condition / 3. / Safety Valve Tested
2. / Piping (Inlet, Outlet, SV Discharge)
Remark:
Inspection Summary:
Person Explained To: / Inspector Signature:
F620-060-000 Inservice Inspection Checklist 05-2012