BOILER ACCEPTANCE INSPECTION REPORT
First and last name or company’s name of the user _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _
Manufacturer’s number of the boiler: _ _ _ _ _ _ _ _ _ Date of purchase: _ _ _ _ _ _ _ _ _
Date of first lighting: _ _ _ _ _ _ _ _ _ _ _
1. IRLEH - Plus boiler – output: _ _ _ _ _ _ _ kW
2. Ventilation system of the boiler room
□* proper □* not proper
3. Chimney duct draft for above mentioned boiler’s output (according to the declaration of the
authorized chimney’s company)
□* in accordance □* not in accordance
4. Protection of the chimney against condensate absorption
□* ceramic chimney inlay □* acid-resistance steel chimney inlay
□* heat-resistance steel chimney inlay □* no protection
5. Expansion tank type “open” in good condition
□* mounted □* not mounted
6. Tank type “closed” in good condition
□* mounted □* not mounted
7. Cooling coil with thermostatic valve SS20
□* mounted □* not mounted
8. Thermostatic valve with 61°C on return
□* mounted □* not mounted
9. Boiler output in accordance to the heated room(s) space
□* proper □* not proper
10. Additional fitting connected to the installation:
□* mixing valve □* other
11. Humidity of fuel 15-25%
□* yes □* not
12. First startup of the boiler performed by the authorized service employee
□* yes □* not
13. Remarks and recommendations (of the user, installer, service employee):
□* installation must be improved (service employee remarks) acc. To point
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
14. □* Warranty will be signed after reparation of defect(s) and falsit(ies) of installation mentioned
above and after repeated startup of the boiler.
NOTE! The user declares that he/she read the
Operation and Maintenance Manual
and Instruction
Manual of this boiler. In case of improper boiler connection, all costs of repeated startup(s) will be
covered by the user.
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Date, signature and stamp of the User’s signature
person responsible for installation
of the boiler
FINAL RESOLUTION:
Herewith I confirm that the device was started up in accordance to valid technical regulations
and guidelines mentioned in the DTR. The boiler works properly
.
date and signater of the
authorized installer
*
) Please tick the box corresponding to the actual state !!
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General