OFFICE OF THE STATE FIRE MARSHAL

DIVISION OF BOILER & PRESSURE VESSEL SAFETY

1035 STEVENSON DRIVE

SPRINGFIELD, IL  62703-4259

(217)782-2696

FAX:  (217)782-1062

Section 120.APPENDIX A   Operational and Maintenance Log

Section 120.EXHIBIT A   Hot Water Heating Boilers

Operational and Maintenance Log

Building:

Month:

Year:

Hot Water Heating Boilers

Address:

Fuel Type:

Person(s) to be Notified in Emergency (Name and Telephone No.)

Illinois No.:

CHECKS (Enter Date)

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

(1) Record Pressure

(2) Record Boiler Water Temp.

(3) Record Flue Gas Temp.

CHECKS (Enter Date)

(1) Observe Flame Condition

WEEK 1

WEEK 2

WEEK 3

WEEK 4

(2) Observe Circulating Pumps

CHECKS (Enter Date)

(1) Manual Lift Safety Valve

(A) Flame Detection Devices

(F) Refractory

(B) Limit Controls

(G) Stop Valves

(2) Review Condition of

(C) Operating Controls

(H) Check Valves

or Test Each Item

(D) Floor Drains

(I) Drain Valves

(E) Fuel Piping

(J) Linkages

(3) Observe Gage Glass on Expansion Tank

(4) Combustion Air Adequate/Unobstructed

General Comments: