‫الــفـــريــــق الســتــشــــارات الســـالمــــة‬

TEAM SAFETY CONSULTANTS L.L.C

EXAMINATION AND TEST OF THERMIC FLUID HEATER

Job No.: Certificate/Report No.:

Name & Address of the Owner of the Boiler: Name & Address of the Manufacturer of the Boiler:

Location: Survey Requested by: Type of Inspection:

Serial No.: Year of Manufacture / Installation : Type/ Model:

Design Temperature: Capacity: Fuel In Use:

Set Outlet Temperature Cut Off: Set Inlet Temperature Cut On: Oil Circulation Pump On / Off:

Burner Cut In: Burner Cut Off: Safety Valve Blow Off:

Inlet Pressure: Outlet Pressure: Safety Valve Type:

Inlet Pressure Gauge Range : Outlet Pressure Gauge Range : Safety Valve Details :

TSC Test Method No.: TSC Test Equipment No.: Reference Regulation:

TSC / TM / TSC / EQ /
Date of Previous Test: Previous Test Done By:

Date of Test: Date of Expiry:

Name and position of person who EQUIPMENT STATUS:

carried out the inspection and test:

SATISFACTORY
_______________ NOT SATISFACTORY
Inspection Engineer

TEAM SAFETY CONSULTANTS, TRADE LICENSE NO. 500714, AL-GARHOUD, P. O. BOX: 112349, DUBAI -UAE,
TEL: 04-2828868,FAX: 04-2865265 EMAIL: info@tsc-uae.ae, WEBSITE: https://www.tsc-uae.ae/

TSC-F-91J (Rev.03) (22/01/2023) Page 1 of 2

Continuation of Job No.: Certificate/Report No.:

Thermic Fluid Heater Check List A B C Remarks

DOCUMENTATION
Equipment manufacturer’s instruction & operational
manual & last test report/certificate details available
VISUAL & FUNCTIONAL TEST
Main Inlet Valve
Main Outlet Valve
Electrical Condition(cables,panels,breakers)
Earth Ground Continuity
Access Ladder & Platform Condition
HouseKeeping
Pressure Relieve Valve
Circulation Pump Condition
Thermic Fluid Level Controller
Insulations Conditions
Flame Failure
Safeties & Controls
Internal Condition of Heater
Pipe Condition & Attachments
Mountings
Lagging & Insulation
Foundation / Base Condition
Pressure Gauges
Furnace Material Condition
General Condition
Door Gaskets
Diesel Pump Condition
OPH tank Condition (FO & LSHSD)

Automatic Temperature Switch On / Off

Maintenance
A - Satisfactory B – Not Satisfactory C – Not Applicable
RECOMMENDATION / REMARKS / RESULT

TSC-F-91J (Rev.03) (22/01/2023) Page 2 of 2