Broseley eVolution 5 - Commissioning Form

Commissioning Form
Commissioning Statement and Check-list
Stove Purchased From:_____________________________________________________
Address:_________________________________________________________________
Telephone Inc area code:____________________________________________________
Installation Date:_____/_____/__________ Stove Name:_________________________
Product Serial Number:________________ Invoice Number:_______________________
Stove installed by:_________________________________________________________
Address:_________________________________________________________________
Telephone Inc area code:____________________________________________________
HETAS Registration Number:________________________________________________
Check-list
Is the flue system the correct length and diameter for stove: Yes No
Flue swept and checked for soundness: Yes No
Manufacturers clearances adhered: Yes No
Smoke spillage test performed on stove: Yes No
Stove controls fully explained to end user: Yes No
Correct fuels explained to end customer: Yes No
CO Alarm fitted and tested: Yes No
Instruction booklet & HETAS certificate handed to end user: Yes No
Signature:__________________________ Print Name:___________________________
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