28
© 2021 United States Stove Company
It is recommended that your heating system is serviced regularly and that the appropriate Service Interval Record is
completed.
SERVICE PROVIDER
Before completing the appropriate Service Record below, please ensure you have carried out the service as described in
the manufacturer’s instructions. Always use the manufacturer's specified spare part when replacement is necessary.
Service 01
Date: ______________________
Engineer Name: ____________________________________
License No.: ________________________________________
Company: __________________________________________
Telephone No.: _____________________________________
Stove Inspected: Chimney Swept:
Items Replaced: ____________________________________
Service 03
Date: ______________________
Engineer Name: ____________________________________
License No.: ________________________________________
Company: __________________________________________
Telephone No.: _____________________________________
Stove Inspected: Chimney Swept:
Items Replaced: ____________________________________
Service 05
Date: ______________________
Engineer Name: ____________________________________
License No.: ________________________________________
Company: __________________________________________
Telephone No.: _____________________________________
Stove Inspected: Chimney Swept:
Items Replaced: ____________________________________
Service 07
Date: ______________________
Engineer Name: ____________________________________
License No.: ________________________________________
Company: __________________________________________
Telephone No.: _____________________________________
Stove Inspected: Chimney Swept:
Items Replaced: ____________________________________
Service 02
Date: ______________________
Engineer Name: ____________________________________
License No.: ________________________________________
Company: __________________________________________
Telephone No.: _____________________________________
Stove Inspected: Chimney Swept:
Items Replaced: ____________________________________
Service 04
Date: ______________________
Engineer Name: ____________________________________
License No.: ________________________________________
Company: __________________________________________
Telephone No.: _____________________________________
Stove Inspected: Chimney Swept:
Items Replaced: ____________________________________
Service 06
Date: ______________________
Engineer Name: ____________________________________
License No.: ________________________________________
Company: __________________________________________
Telephone No.: _____________________________________
Stove Inspected: Chimney Swept:
Items Replaced: ____________________________________
Service 08
Date: ______________________
Engineer Name: ____________________________________
License No.: ________________________________________
Company: __________________________________________
Telephone No.: _____________________________________
Stove Inspected: Chimney Swept:
Items Replaced: ____________________________________
SERVICE RECORD
© 2021 U
nited S
tat
es Sto
ve C
ompany
27
ENREGIS
TREMENT DE SERVICE
Il es
t rec
ommandé que
votr
e sys
tème
de cha
uffag
e est des
ser
vi ré
gulièr
ement e
t que
le Servic
e In
ter
val
enregis
tremen
t approprié
est t
erminée.
FO
URNISSEUR DE SER
VICES
Avan
t de terminer
l’enr
egis
tremen
t de s
ervic
e approprié
ci-des
sous,
s’il v
ous plaît
vous
ass
urer que
vous
ave
z eff
ectué le
ser
vice
tel
que décrit dans le les instr
uctions du f
abrican
t. T
oujours utilis
er pièce de r
echange indiquée par le f
abrican
t lors de r
emplacemen
t
est néc
essair
e.
Servic
e de 01
Date
: ______________________
Nom de l’ing
énieur: _________________________________
N° de licenc
e.: ______________________________________
Compa
gnie: ________________________________________
N° de téléphone:
___________________________________
Poêle
Inspecté:
Cheminée balayée:
Articles R
emplacé:
_________________________________
Servic
e de 03
Date
: ______________________
Nom de l’ing
énieur: _________________________________
N° de licenc
e.: ______________________________________
Compa
gnie: ________________________________________
N° de téléphone:
___________________________________
Poêle
Inspecté:
Cheminée balayée:
Articles R
emplacé:
_________________________________
Servic
e de 05
Date
: ______________________
Nom de l’ing
énieur: _________________________________
N° de licenc
e.: ______________________________________
Compa
gnie: ________________________________________
N° de téléphone:
___________________________________
Poêle
Inspecté:
Cheminée balayée:
Articles R
emplacé:
_________________________________
Servic
e de 07
Date
: ______________________
Nom de l’ing
énieur: _________________________________
N° de licenc
e.: ______________________________________
Compa
gnie: ________________________________________
N° de téléphone:
___________________________________
Poêle
Inspecté:
Cheminée balayée:
Articles R
emplacé:
_________________________________
Servic
e de 02
Date
: ______________________
Nom de l’ing
énieur: _________________________________
N° de licenc
e.: ______________________________________
Compa
gnie: ________________________________________
N° de téléphone:
___________________________________
Poêle
Inspecté:
Cheminée bala
yée:
Articles R
emplacé:
_________________________________
Servic
e de 04
Date
: ______________________
Nom de l’ing
énieur: _________________________________
N° de licenc
e.: ______________________________________
Compa
gnie: ________________________________________
N° de téléphone:
___________________________________
Poêle
Inspecté:
Cheminée bala
yée:
Articles R
emplacé:
_________________________________
Servic
e de 06
Date
: ______________________
Nom de l’ing
énieur: _________________________________
N° de licenc
e.: ______________________________________
Compa
gnie: ________________________________________
N° de téléphone:
___________________________________
Poêle
Inspecté:
Cheminée bala
yée:
Articles R
emplacé:
_________________________________
Servic
e de 08
Date
: ______________________
Nom de l’ing
énieur: _________________________________
N° de licenc
e.: ______________________________________
Compa
gnie: ________________________________________
N° de téléphone:
___________________________________
Poêle
Inspecté:
Cheminée bala
yée:
Articles R
emplacé:
_________________________________
