DEPARTMENT OF LABOR AND INDUSTRY
PHONE: (804) 786-3169
BOILER SAFETY COMPLIANCE PROGRAM
FAX: (804) 371-2324
13 SOUTH THIRTEENTH STREET
RICHMOND, VA 23219
Dear Owner/User:
In our continual efforts to improve upon the quality of our service, would you please take a moment to
answer the following questions:
1.
Was the information correct on the Certificate of Inspection?
YES or NO
Owner/users name and address
Location of equipment
Date of Inspection
If NO, please explain___________________________________________________________________________
___________________________________________________________________________
2.
Did you receive all the certificates for all the vessels which were inspected?
YES or NO
If NO, please explain___________________________________________________________________________
___________________________________________________________________________
3.
What form of payment, other than check or money order, would you prefer?
Credit Card
Debit Card
Electronic Fund Transfer
4.
Is your company’s pertinent personnel familiar with Virginia Boiler and Pressure
YES or NO
Vessels Rules and Regulations?
If NO, please provide mailing address
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
5.
Was your company satisfied with the service of the certificate inspector?
YES or NO
If NO, please explain___________________________________________________________________________
___________________________________________________________________________
You may use the back of this sheet for further comments. Please indicate the question number you are
elaborating on.
Please return this form to the above address.
Thank you for taking time out to complete this survey, and your interest in public safety.
DEPARTMENT OF LABOR AND INDUSTRY
PHONE: (804) 786-3169
BOILER SAFETY COMPLIANCE PROGRAM
FAX: (804) 371-2324
13 SOUTH THIRTEENTH STREET
RICHMOND, VA 23219
Dear Owner/User:
In our continual efforts to improve upon the quality of our service, would you please take a moment to
answer the following questions:
1.
Was the information correct on the Certificate of Inspection?
YES or NO
Owner/users name and address
Location of equipment
Date of Inspection
If NO, please explain___________________________________________________________________________
___________________________________________________________________________
2.
Did you receive all the certificates for all the vessels which were inspected?
YES or NO
If NO, please explain___________________________________________________________________________
___________________________________________________________________________
3.
What form of payment, other than check or money order, would you prefer?
Credit Card
Debit Card
Electronic Fund Transfer
4.
Is your company’s pertinent personnel familiar with Virginia Boiler and Pressure
YES or NO
Vessels Rules and Regulations?
If NO, please provide mailing address
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
5.
Was your company satisfied with the service of the certificate inspector?
YES or NO
If NO, please explain___________________________________________________________________________
___________________________________________________________________________
You may use the back of this sheet for further comments. Please indicate the question number you are
elaborating on.
Please return this form to the above address.
Thank you for taking time out to complete this survey, and your interest in public safety.