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Industrial Commission of Arizona
Protection of life, health, safety, and welfare of Arizona's workforce

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    • Special Fund Division
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    • News and Events
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  • Request for Boiler Repair Form

Request for Boiler Repair Form

Instructions

 

An owner, user or licensed contractor must request an inspection prior to performing an alteration or repair of a boiler or a fired pressure vessel in the State of Arizona, in accordance with Arizona Administrative Code, R20-5-404.B, and R20-5-406. This form may be used to make this request.

The following provisions must be met or the request will not be accepted:

  1. The boiler or fired pressure vessel must be constructed in a manner which meets the standards of the Arizona Administrative Code, Boiler Rules: R20-5-404.
  2. The owner, user or licensed contractor shall have on-site the Manufacturer's Data Report for the boiler and/or fired pressure vessel, and any other Manufacturer's manuals/documents pertinent to the contemplated alteration or repair.
  3. Non-weld alterations or repairs shall be performed by an installer holding a current contractor's license issued pursuant to Chapter 10, Title 32, A.R.S. §32-1122, which authorizes the licensee to perform boiler or fired pressure vessel work.
  4. This Inspection Request is not for welded alterations or repairs. Alteration or repair of a boiler or fired pressure vessel involving welding shall be performed by an organization accredited by the National Board of Boiler and Pressure Vessel Inspectors as stipulated in A.A.C. R20-5-404B.


This form must be completed in its entirety.  Failure to do so may cause a delay in processing. It can be submitted online or it can be submitted to ADOSH by mail, fax, or hand-delivery.

Printer-Friendly Form

PDF icon ADOSH_RequestBoilerRepair_Master.pdf

Related Forms

Report a Fatality or Severe Injury Form
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ADOSH Training Request Form
Application for Permit to Install or Alter Elevator Form
Elevator Inspection (PEI) New Application
Request for Boiler Repair Form
Request for Boiler Certificate Form
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SHARP Application Form

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800 W. Washington Street
Phoenix AZ 85007
602-542-4661

 

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Tucson AZ 85716
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