Doc ref: URS -CL-12A-REV1.

0(15-01-2019)

s– Cert/Report No.
Job no:
GENERAL INFORMATION
Name of the Company Prev. Inspection date

Equipment Location Type of Inspection

Name of the Equipment Reference standard

URS ITP Ref No. Date of inspection

Inspection requested by: Date of expiry

EQUIPMENTDETAILS
Description of the Max. Working
equipment Temperature
Name of the Rated Power
Manufacturer
Manufacturing year Fuel Used

Serial/ ID No: Temperature Switch

Cut In/ Cut Off
Capacity Tube Thickness

Design Pressure Drum Thickness

Hydraulic Test Pressure Safety Relief Valve

Type
Hydraulic Test Duration Safety Relief Valve
Pop Up Pressure
Temperature Gauge Safety Valve Capacity
Range
Pressure Gauge Range Company ID No

INSPECTION CHECKLIST
S/N Inspected Component Observation S/N Inspected Component Observation
A B C D A B C D
1. Manufacturers Instruction/Previous 12. Feed water Pump Cut In/ Cut Off
Certificate
2. Main feed water valve/Make up water 13. Conditions of insulation
3. Main steam valve/Water Outlet Valve 14. Conditions of tubes and pipes
4. Pressure gauges 15. Internal surface
5. Safety relief valve 16. Foundation/Base Condition
6. Condition of feed pump 17. Condition of mud hole doors
7. Condition of electrical connections 18. Accessibility
8. Condition of access ladder & platform 19. Flame Scanner
9. Blow down valve/Drain Valve 20. Water Column/ Sight Glass
10. Water treatment condition 21. Boiler Room
11. Low water level alarm/indicator 22. Condition of Drum

A- Satisfactory B- Not Satisfactory C- Recommendation D - Not applicable

Job No. Cert/Report No.

RECOMMENDATIONS/COMMENTS

Name of the Inspection Engineer Signature:

Date:

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