Heading and items 1 to 3: building and vessel
City and state, building, region number, headquarters, date of inspection, the number of unfired pressure vessels in the building subject to inspection, the plant pressure vessel number and the manufacturer's name and number.
Items 4 to 13A: type, build and rating
The type of vessel, such as boiler feed heater, compressed air tank, domestic hot water tank, hydro-pneumatic tank or liquid receiver, plus supports, dates, shell construction, material and dimensions, service, manufacturer's rating and operating pressure.
Items 14 to 21: last inspection and tubes
Date and inspector of the last inspection, the heating or cooling medium (steam, water, ammonia, F-11, F-12 or other), the heat transfer surface and the number, length, diameter, material and gauge of tubes.
Items 22 to 33: condition and pressure test
General condition, corrosion protection, oil, grease or scale, pitting, distortion, corrosion inhibitor, tube supports, the hydrostatic or pneumatic test pressure applied, any defects and the recommended maximum safe working pressure.
Items 34 to 52: valves, gauges and personnel
Pressure relief valves and temperature protection, other controls, gauges and thermometers, safety plugs, gauge glass, pipe connections, header manifold, a tightness test, repairs since the last inspection, toxic gas and fire fighting provisions, and a grade for the personnel in charge.
Items 53 to 55B: opinion and signatures
Whether the vessel is in a safe condition to be operated, the inspector's recommendations and signature, and the remarks and signature of the local officer or engineer in charge.
The 55 numbered items run across four pages.