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Version 1, 15 June 2020, 15 of 16
Galvin Engineering Thermostatic Mixing Valve or
Tempering Valve Commissioning Report
Valve Location/Building : ____________________________________________________________________
Room or Area: ____________________________________________________________________________
Work Order No.: ___________________________________________________________________________
Warm
Water
Outlet
Fixture
No.
*Name/Type/Size and location
of Outlet Fixture (Bath, Shower,
Basin, Other)
Flow rate of Design Water (LPS) Temp of Warm Water (C)
One Outlet
in Use
**All Req‘d
Outlets in Use
One Outlet
in Use
**All Req’d
Outlets in
Use
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
*Give details of brand and model designation.
** Commensurate with the design flow rate for the mixing valve.
Note: An accurate digital thermometer is necessary for the temperature measurements
Prescribed temperature range for warm water ______________ C to _________________C
Thermal shutdown at both minimum and maximum design flow rates
(Passed/Failed) Yes
□
No
□
Name of Plumber: ___________________________________________
License/Cert No. ____________________________________________________________________________
icensee’s ignature: _______________________________ Date: ___________________________________
Telephone Number: _________________________________________________________________________
