DEPARTMENT OF VETERANS AFFAIRS
BOILER SAFETY DEVICES - OPERATION CHECK LIST
HOSPITAL_________________________PROJECT NO. _______________DATE_________BOILER NO. ________________
BOILER MAKE AND MODEL
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BURNER MAKE AND MODEL
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TECHNICIAN AND COMPANY
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VA REPRESENTATIVE
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Not
Item
OK
OK
Set Point - Remarks
Low Water Cutoff
[
]
[
]
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Aux. Low Water Cutoff
[
]
[
]
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High Water Alarm
[
]
[
]
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Low Water Alarm
[
]
[
]
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Low Water Cutoff Shunt Switch
[
]
[
]
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Aux. Low Water Cutoff Shunt Switch
[
]
[
]
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High Steam Press. Cutout - Recycle
[
]
[
]
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High Steam Press. Cutout - Non-Recycle
[
]
[
]
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Steam Safety Valve No. 1 - Pop
[
]
[
]
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Blowdown
[
]
[
]
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Steam Safety Valve No. 2 - Pop
[
]
[
]
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Blowdown
[
]
[
]
_____________________________________________
Steam Safety Valve No. 3 - Pop
[
]
[
]
_____________________________________________
Blowdown
[
]
[
]
_____________________________________________
Steam Safety Valve No. 4 - Pop
[
]
[
]
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Blowdown
[
]
[
]
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Main Gas
High Pressure Cutoff
[
]
[
]
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Low Pressure Cutoff
[
]
[
]
_____________________________________________
Safety Shut-Off Valves Proof of Closure
[
]
[
]
_____________________________________________
Leak Test Safety Shut-Off Valves
[
]
[
]
_____________________________________________
Oil
High Pressure Cutoff
[
]
[
]
_____________________________________________
Low Pressure Cutoff
[
]
[
]
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High Temperature Cutoff (Heated Oil)
[
]
[
]
_____________________________________________
Low Temperature Cutoff (Heated Oil)
[
]
[
]
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Low Atomizing Pressure
[
]
[
]
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Low Atomizing/Oil Differential Pressure
[
]
[
]
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Oil Burner Position Switch
[
]
[
]
_____________________________________________
Safety Shut-Off Valves Proof of Closure
[
]
[
]
_____________________________________________
Leak Test Safety Shut-Off Valves
[
]
[
]
_____________________________________________
Cold Start/Steam Atomizing Burners
[
]
[
]
_____________________________________________
LP Gas Ignitor Operation
[
]
[
]
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Ignitor (Pilot)
Low Gas Pressure
[
]
[
]
_____________________________________________
Leak Test Safety Shut-Off Valves
[
]
[
]
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Forced Draft Motor Interlock
[
]
[
]
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F. D. Damper Open Wide for Purge
[
]
[
]
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Outlet Damper Open Wide for Purge
[
]
[
]
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Purge Air Flow Interlock
[
]
[
]
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Purge Timing
[
]
[
]
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Ignition Timing
[
]
[
]
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Low Fire Position Interlock
[
]
[
]
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Combustion Air Flow Interlock
[
]
[
]
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Main Flame Out - Time to Close Valves
[
]
[
]
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Ignition Flame Out - Time to Close Valves
[
]
[
]
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Minimum Ignitor Flame Test
[
]
[
]
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Scanner Not Sensing Ignition Spark
[
]
[
]
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Control Air Pressure Interlock
[
]
[
]
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Sound Level - High Fire
[
]
[
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