Boiler Operation Safety Inspection Form

Date of Inspection Inspector Name Boiler Location Boiler ID / Serial

Item	Check	Remarks
Boiler appearance (no leaks, cracks)	Pass Fail N/A
Pressure gauge operational	Pass Fail N/A
Water level indicators functional	Pass Fail N/A
Safety valve working	Pass Fail N/A
Emergency shut-off tested	Pass Fail N/A
Burner controls operating correctly	Pass Fail N/A
Ventilation unobstructed	Pass Fail N/A

General Observations

Recommendations / Corrective Actions

Inspector Signature Time