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FURNACE INSPECTION DOCUMENTATION CHILD CARE PROVIDER’S NAME: TYPE OF HEATING SOURCES: 1. Stove and heater locations do not block escape routes. 2. Gas, coal, wood, kerosene or oil heater is vented to the outside in accordance with the State Building Code. 3. Combustible items are not located within 36 inches of the furnace or other heating sources. 4. All fireplaces, wood burning stoves, heaters, radiators and furnaces are installed according to the State Building Code. 5. The furnace and hot water heater are inaccessible to children. Separation must allow for proper air circulation to the furnace. 6. Ventilation of usable space must meet requirements of the State Building Code. 7. The heat exchanger is working properly and is safe. 8. Flue and chimney are installed correctly and are safe to use. 9. Filter and furnace are clean and in good condition. 10. Natural gas piping was checked for leaks. No leaks were found. 11. The gas appliance venting was inspected. No problems with the venting were noted. DATE OF HEATING INSPECTION: NAME OF HEATING CONTRACTOR: BUSINESS NAME AND ADDRESS: PHONE NUMER OF HEATING CONTRACTOR: LICENSE NUMBER OF HEATING CONTRACTOR: SIGNATURE OF HEATING CONTRACTOR: SIGNATURE OF CHILD CARE PROVIDER: CCSS (06-2010)