DNA Clean Sweep LLC. (General Condition Report)

DNA Clean Sweep LLC.

Office 510-200-9775

San Francisco, East Bay, Tri Valley California

The Woodlands, Spring, Conroe. Texas

Half of our Business is making you happy,

The other half is keeping you that way.
DNA Clean Sweep LLC. (General Condition Report)

Keeping you and your Family Safe from Fire, Smoke, And Earthquake Hazards. Since 1999
Customer
Address
City
State
Zip
Phone Number
Please enter a valid phone number.
E mail
example@example.com
Time
Directions to Home
# of Stories

1234 or more
System Last Cleaned
Amount of fuel burned per season
Flue Size OD

8x88x1313x138x1713x176 R8 R10 R (or Bigger list in Notes OD)
Outside Chimney Dimensions
Fireplace Opening Size
RECEIPT/INVOICE

RECEIPT/INVOICE
Listed Service/s Performed (Inspect / Clean / Etc.)
TOTAL
CUSTOMER VERIFICATION

CUSTOMER VERIFICATION
I understand the service/s performed and this report will explain which areas of my chimney system appear to be satisfactory (Pass) and which areas are not satisfactory(Fail).
Signed

Clear
Date

MonthDayYear
Date
The National Fire Protection Association Standard states the fire- place and chimney should be inspected yearly for any structural faults
NEXT SERVICING SCHEDULED

NEXT SERVICING SCHEDULED
month
day
year
time
Chimney Tech
Chimney Professional's Signature

Clear
# of Appliances

1234 or more
Type of Appliance

PrefabMasonryStoveInsert
Fuel Type

WoodPelletOilGas
Type of wood used

SoftHardWetDry
Chimney

Chimney
Height (3 - 2 - 10 Rule)

Pass (may need General Maintenance see notes)FailNot ApplicablePass
Chimney Cap / Spark Arrestor

PassPass (May need General Maintenance see notes)FailN/A
Crown Wash /Chase Pan

PassFailNAPass (Needs Maintenance see notes)
Brickwork / Mortar

PassFailNAPass (Needs Maintenance see notes)
Flashing

PassFailNAPass (Needs Maintenance see notes)
Flue Liner

PassFaillNAPass (Needs Maintenance see notes)
Moisture Resistance

PassFaillNAPass (Needs Maintenance see notes)
Fireplace

Fireplace
Smoke Chamber

PassFaillNAPass (Needs Maintenance see notes)
Damper

PassFaillNAPass (Needs Maintenance see notes)
Firebox / Grate

PassFaillNAPass (Needs Maintenance see notes)
Ash Container

PassFaillNAPass (Needs Maintenance see notes)
Spark Screen / Doors

PassFaillNAPass (Needs Maintenance see notes)
Tools / Gloves

PassFaillNAPass (Needs Maintenance see notes)
Hearth Protection

PassFaillNAPass (Needs Maintenance see notes)
Stove or Fireplace insert

Stove or Fireplace insert
Connector Pipe Condition

PassFaillNAPass (Needs Maintenance see notes)
NFPA/IRC Approved Connection and Flue

PassFaillNAPass (Needs Maintenance see notes)
Insullation/Thimble/Clearance

PassFaillNAPass (Needs Maintenance see notes)
OTHER SAFETY CONSIDERATIONS

OTHER SAFETY CONSIDERATIONS
Fire Ext/Smoke Detection/Co Alarms

PassFaillNAPass (Needs Maintenance see notes)
Gas/Oil Furnace Flue Liner

PassFaillNAPass (Needs Maintenance see notes)
Fire Escape Plane

PassFaillNAPass (Needs Maintenance see notes)
Note This sheet . the result of visual inspection done - the time of cleaning : intended convenience curitomer, not a certification fire worthiness or safety Since conditions of use and hidden construction defects - beyond our control, - make no warranty of the safety or function of any appliance and none is to be implied.
Chimney Tech Notes:
Recommended Hazard / General Maintenance Repairs
PHOTOS
Downloaded Photos

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Should be Empty:

DNA Clean Sweep LLC. (General Condition Report)

RECEIPT/INVOICE

CUSTOMER VERIFICATION

NEXT SERVICING SCHEDULED

Chimney

Fireplace

Stove or Fireplace insert

OTHER SAFETY CONSIDERATIONS