rebmun enohpeleT :eman remotsuC
Address:
Model:
Serial number
Installing Company Name:
Installing Engineer’s Name:
State Chimney Designaon:
Confirm Hearth Installaon Is Correct
Bedroom Lounge Other: Specify_________________________
Chimney System: New Insulated Factory Made Chimney System Installed? Yes No
himney: Twin Wall Flexible Liner (for Clas tal
Commissioning
Confirm proper placement of internal parts Check soundness of d
s for this model
ontrols Confirm all flue pipe co
Confirm the stove properly draught when fired
Check to insure a CO alarm is installed in the same room as the
ne maintenance requirements
oved Document J Appendix E
Confirm you have commissioned and tested the appliance and assoc
As the competent person responsible for the work described above, I confirm that the appliance and
associated work has been installed in accordance with and compl
proved Documents J,G & L as applicable.
Signed:__________________________________Print Name:________________________________Date:____________________
This form should be retained by the customer for future reference.
Commissioning Checklist
This Commissioning Checklist is to be completed in full by the competent person who commissioned the stove as a means of
s and then handed to the customer to keep for future refer-
ence.
Failure to install and commission according to the manufacturer e Commissioning Checklist will
invalidate the warranty. This does
Please Print
not affect the customer’s statutory rights.
