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SCHEDULE.
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Report of Explosion of a Steam Boiler to be sent to the Board of Trade within twenty-four hours after the occurrence of an Explosion.
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See Section 5.
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1. Name of premises or works on which the boiler exploded.
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2. Address by the post.
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3. Day and hour of explosion
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4. Number of persons killed.
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5. Number of persons injured.
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6. General description of the boiler.
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7. Purposes for which the boiler was used.
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8. Part of the boiler which failed, and the extent of failure generally.
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9. Pressure at which the boiler was worked.
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10. Name and address of any society or association by whom the boiler was last inspected or insured.
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Signature of person responsible for the accuracy of the particulars contained in this form.
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Address
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Date
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