Version 3, 14 December 2018, Page
14
of
16
Galvin
Engineering
Thermostatic Mixing Valve or Tempering
Valve Commissioning Report and/or Maintenance Report
Test Results
Valve considered satisfactory for use: Yes
□
No
□
If No, state the reason and action taken:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Commissioning Work
It is hereby certified that all the commissioning work has been carried out by the undersigned in accordance with the
requirements of the Codes of Practice indicated prior.
Date of Valve Commissioned:
__________________________________________________________________________
Name of Licensed Plumber: _______________________________ License/Cert No: _____________________
License Plumbers Signature: __________________________________________________________________
Telephone No. _____________________________________________________________________________
Owner/occupiers signature: ________________________________________________Date: ______________
Date of Initial Service Due: ___________________________________________________________________
