NOV12GB Issue 2
25
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:___________________________
