<p> DEPARTMENT OF VETERANS AFFAIRS BOILER SAFETY DEVICES - OPERATION CHECK LIST</p><p>HOSPITAL______PROJECT NO. ______DATE______BOILER NO. ______BOILER MAKE AND MODEL ______BURNER MAKE AND MODEL ______TECHNICIAN AND COMPANY ______VA REPRESENTATIVE ______Not Item OK OK Set Point - Remarks</p><p>Low Water Cutoff [ ] [ ] ______Aux. Low Water Cutoff [ ] [ ] ______High Water Alarm [ ] [ ] ______Low Water Alarm [ ] [ ] ______Low Water Cutoff Shunt Switch [ ] [ ] ______Aux. Low Water Cutoff Shunt Switch [ ] [ ] ______High Steam Press. Cutout - Recycle [ ] [ ] ______High Steam Press. Cutout - Non-Recycle [ ] [ ] ______Steam Safety Valve No. 1 - Pop [ ] [ ] ______Blowdown [ ] [ ] ______Steam Safety Valve No. 2 - Pop [ ] [ ] ______Blowdown [ ] [ ] ______Steam Safety Valve No. 3 - Pop [ ] [ ] ______Blowdown [ ] [ ] ______Steam Safety Valve No. 4 - Pop [ ] [ ] ______Blowdown [ ] [ ] ______Main Gas High Pressure Cutoff [ ] [ ] ______Low Pressure Cutoff [ ] [ ] ______Safety Shut-Off Valves Proof of Closure [ ] [ ] ______Leak Test Safety Shut-Off Valves [ ] [ ] ______Oil High Pressure Cutoff [ ] [ ] ______Low Pressure Cutoff [ ] [ ] ______High Temperature Cutoff (Heated Oil) [ ] [ ] ______Low Temperature Cutoff (Heated Oil) [ ] [ ] ______Low Atomizing Pressure [ ] [ ] ______Low Atomizing/Oil Differential Pressure [ ] [ ] ______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 [ ] [ ] ______Ignitor (Pilot) Low Gas Pressure [ ] [ ] ______Leak Test Safety Shut-Off Valves [ ] [ ] ______</p><p>Forced Draft Motor Interlock [ ] [ ] ______F. D. Damper Open Wide for Purge [ ] [ ] ______Outlet Damper Open Wide for Purge [ ] [ ] ______Purge Air Flow Interlock [ ] [ ] ______Purge Timing [ ] [ ] ______Ignition Timing [ ] [ ] ______Low Fire Position Interlock [ ] [ ] ______Combustion Air Flow Interlock [ ] [ ] ______Main Flame Out - Time to Close Valves [ ] [ ] ______Ignition Flame Out - Time to Close Valves [ ] [ ] ______Minimum Ignitor Flame Test [ ] [ ] ______Scanner Not Sensing Ignition Spark [ ] [ ] ______Control Air Pressure Interlock [ ] [ ] ______Sound Level - High Fire [ ] [ ] ______Fan Motor Amps [ ] [ ] ______Low Oxygen Alarm [ ] [ ] ______Boiler Soot Blower Operation and Alignment [ ] [ ] ______Economizer Soot Blower Operation [ ] [ ] ______Flue Gas Recirculation Damper Set for Prepurge [ ] [ ] ______[ ] [ ] ______</p><p>VACO 183A 2/7/00</p>