Version 3, 14 December 2018, Page
13
of
16
Galvin
Engineering
Thermostatic Mixing Valve or Tempering
Valve Commissioning Report and/or Maintenance Report
Note:
1.
Please use a separate form for each valve.
2.
The original copy of the report is to be given to the owner/occupier and retained on site for a minimum of 7 years.
Cross off appropriate box
□
Thermostatic Mixing Valve
□
Tempering Valve
□
Commissioning Report
□
Maintenance Report
□
Name of Establishment: ____________________________________________________________________
Address of Establishment: ____________________________________________________________________
Phone Number: _____________________________ Date: _____________________ Work Order #: _______
Contact Person: _______________________ Make & Model of Hot Water System: ________________ ______
Temperature of Hot Water to the Valve: _____________ Temperature of Cold Water to the Valve: ______________
Hot Water Pressure: ________kPa Cold Water Pressure: _______kPa
Make of Mixing Valve: _______________________ Model No: ________________________ Size: _________
Valve Location/Building: _____________________________________________________________________
Valve Identification No: ______________________________________________________________________
Total No of Valves on the Site/Building: _________________________________________________________
No of Outlets Serviced by this Valve: Baths ( ) Basins ( ) Showers ( )
Other Outlets - Details ______________________________________________________________________
Valves Installed to the requirements of:
The Valves manufacturers requirements
Yes
No
The specifications and drawings for the project
Yes
No
The Local Water Supply or Authority
Yes
No
If No, give details and actions taken:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
________________________
