Glow-worm 12 hxi G.C.No. 41-019-01, Installation And Servicing, Page: 46 / 48

SERVICE INTERVAL RECORD
It is recommended that your heating system is serviced regularly
and that you complete the appropriate Service Interval Record Below .
Service Provider. Before completing the appropriate Service Interval Record below, please ensure you have carried out the service
as described in the boiler manufacturer’s instructions. Always use the manufacturer ‘s specified spare part when replacing all controls.
SERVICE 1
Date
Energy Effi ciency Checklist completed?
Yes
No
Engineer Name
Company Name
Telephone Number
Engineer ID Number
Comments
Signature
SERVICE 3
Date
Energy Effi ciency Checklist completed?
Yes
No
Engineer Name
Company Name
Telephone Number
Engineer ID Number
Comments
Signature
SERVICE 5
Date
Energy Effi ciency Checklist completed?
Yes
No
Engineer Name
Company Name
Telephone Number
Engineer ID Number
Comments
Signature
SERVICE 7
Date
Energy Effi ciency Checklist completed?
Yes
No
Engineer Name
Company Name
Telephone Number
Engineer ID Number
Comments
Signature
SERVICE 9
Date
Energy Effi ciency Checklist completed?
Yes
No
Engineer Name
Company Name
Telephone Number
Engineer ID Number
Comments
Signature
SERVICE 2
Date
Energy Effi ciency Checklist completed?
Yes
No
Engineer Name
Company Name
Telephone Number
Engineer ID Number
Comments
Signature
SERVICE 4
Date
Energy Effi ciency Checklist completed?
Yes
No
Engineer Name
Company Name
Telephone Number
Engineer ID Number
Comments
Signature
SERVICE 6
Date
Energy Effi ciency Checklist completed?
Yes
No
Engineer Name
Company Name
Telephone Number
Engineer ID Number
Comments
Signature
SERVICE 8
Date
Energy Effi ciency Checklist completed?
Yes
No
Engineer Name
Company Name
Telephone Number
Engineer ID Number
Comments
Signature
SERVICE 10
Date
Energy Effi ciency Checklist completed?
Yes
No
Engineer Name
Company Name
Telephone Number
Engineer ID Number
Comments
Signature