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CHECKLIST/INSTALLATION REPORT
Checklist and confirmation of completed inspection of chimney installation
Address
Post code
Town/city
Owner’s name
Installer (company)
Name
Address
Post code
Town/city
Type of chimney
Dimensions
No. of fireplaces connected to the chimney
Height of chimney
Offset
Roofing
YES
NO
Has the chimney been installed according to the installation instructions?
COMMENTS:
Has the distance to flammable materials been checked?
COMMENTS:
Has the height above the roof been checked?
COMMENTS:
Has the potential to sweep the chimney been checked?
COMMENTS:
Is there safe access for a chimney sweep on the roof (steps/platform)?
COMMENTS:
Is the chimney designed for connecting a fireplace?
COMMENTS:
Remarks
Address of the property:
Chimney’s designation:
The installation has been checked by an installer during installation:
Inspection certificate
The installation has been checked with the aid of the completed checklist and a visual inspection. The installation has been checked and been found to
be in order:
Town/city
Date
Installer’s signature