Prefabricated Chimney Serving an Appliance - Long Form - PDF
Prefabricated Chimney Serving an Appliance (PCSA) Level 1 and Level 2 checklist was created using NFPA 211 Chapter 15 and the Annex.
Its purpose is to help a sweep complete Levels 1 and 2 with additional questions to
help gather as much information as possible.
The long-form has questions that cover both PCSA Short Forms, so there will be questions about Liquid and Solid fuels. When you come to those questions or sections, you can mark N/P for Non-Applicable or cross out those questions and make a note.
This form is 4pgs long, so it's formatted to Legal-sized paper to print it if needed, but you can also use it on a mobile device or iPad.
Instructions for download:
When you buy this form, you will download a disclaimer we need everyone to read and
sign before we send you the actual form, we are working towards an e-signature
at checkout but we're not there yet.
Upon receiving the signed disclaimer, we will email your purchase. If you are
purchasing more than 1 form at a time, you only need to fill out the disclaimer
A disclaimer will need to be signed for every purchase when forms are bought at different times,
The purchased PDF(s) can be copied onto other computers or devices in your business once downloaded.
IF you would like to edit this PDF, we suggest getting an Adobe DC account.
If you use a Service software like Smart Service/iFleet, you will need to buy the
forms that say 'for Smart service, etc.' This is due to the formatting that is
These are standard fillable forms, so any software you’re using that can upload a PDF
should be able to load these. Also, any device or app that can read or open a
PDF should be able to use these.