Installation & Commissioning Report
Model Number _____________________ Serial Number ___________________________
Date of Installation ________ Address of installation ____________________________
User contact information ______________________________________________________
Installer Information (Company & Address)____________________________________
Phone/Fax/E-mail ______________________________________________________________
Fuel: □Natural Gas □ Propane
Gas Supply Pressure (high fire) ____ Inches w.c. Measured Rate of Input (high fire) _____Btu/hr
□Leak testing completed □ Gas piping □Venting system □Fan □ combustion components
□System Cleaned and Flushed (type of cleaner used) _______________________________
□System Filled (type/concentration of any glycol/chemicals used) ___________________
□Air purge completed
□Relief Valve correctly installed and piped Relief valve “try lever” test performed
□Condensate trap filled Condensate drain clear and free flowing Condensate Neutralization.
□Ignition Safety Shutoff test completed. Flame current reading - High fire _____ µA - Low fire __
___ µA
□Owner advised and instructed in the safe operation and maintenance of the boiler and system.
□Information regarding the appliance and installation received and left with owner
Combustion Readings: CO
2
_____________ % O
2
______________ % CO ____________ ppm
Flue temperature ___ Return water temperature (measure simultaneously with flue temp.) _____
Commissioning has been completed as listed on this report - Installer's Signature _____________
Installers: send this completed sheet - Fax to 604 877 0295 - or - scan and Email to
info@ibcboiler.com.
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