Title Page

  • Site conducted

  • Department (I.E Social Housing, Renewables, BGUKI, BGS&R, 0800S&R, Electrical, ECO, Installs)

  • Operative Name

  • Operative Gas Safe License Card Number

  • Conducted on

  • Inspector

  • Location

Resident Audit / Inspection Authorisation

  • [Pacifica Group Customer Declaration – Including COVID-19 Measures & Sign off]: [The Resident], confirm I authorised Pacifica to carry out an Audit / Inspection and gave my GDPR / Privacy consent to photos being taken during the visit I acknowledge which will be retained as evidences of the work done within the property. [Pacifica Group COVID-19 Statement]: I can also confirm that during the time of the Pacifica visit no-one in the household is showing any symptoms of Coronavirus. Pacifica carried out a Dynamic Risk Assessment prior to accessing my property. The appointment was screened to confirm no resident had symptoms of COVID-19 which was confirmed again prior to Pacifica staff entering the property. Pacifica staff informed me that they have had enhanced Covid-19 training, in line with their Health & Safety Policy which includes the most up to date Government Advice. This ensured that all within the property maintained safe distances and used Covid-safe working practices at all times. To ensure safety for all, I agreed to maintain Social Distancing measures by adopting the required distancing and by staying in a separate room while Pacifica staff were present. Pacifica staff used PPE during the visit which included; Anti-Bacterial Wipes, Surgical Face Masks, Disposable Gloves, Hand Sanitizer and Full Face Visors were available for use. The hand-held was wiped before and after I added my signature to minimise any Covid-19 cross contamination. Copyright © Pacifica Group 2020 | Pacifica Group Limited company number 05541667, Pacifica Home Services Limited company number 04966472, Pacifica Appliance Services Limited company number 05288361, UK Warranty Limited company number 07728040 and Oakes Energy Services Limited company number 06434382 are Registered in England and Wales, Registered Office address Pacifica House, Venter Building, 3 Mandarin Road, Rainton Bridge Business Park, Houghton Le Spring, County Durham, DH4 5RA I

Model Visit - Site Set Up

  • Is the engineers & vehicles appearance satisfactory?

  • Is the works vehicle parked in a safe manner?

  • Has the customer been suitably advised on the installation process and potential hazards?

  • Have the engineers set up the work area in an orderly fashion, keeping access/egress routes free from obstruction?

  • Has action been taken to protect the customer’s property?

  • Is the property/work area clean and tidy?

  • Has identification (Gas Card) been shown on arrival?

Health and Safety - PPE/Work Equipment

  • Has a site Risk Assessment been carried out an available to the Engineer

  • Is all of the appropriate PPE accessible and worn?

  • Is PPE in good condition?

  • Is an RCD available and used when neccassary?

  • Are PAT testing arrangements appropriate, including battery chargers?

  • Is a fire extinguisher located in the vicinity of hot work? Is it pressurised & maintained?

  • Is there a system in place for access equipment inspections?

  • Are Tools and Equipment maintained in a suitable manner?

  • Have safe working practices and a suitable conduct been observed?

Environmental

  • Is waste segregated? (at a minimum, hazardous & non-hazardous)?

  • Are engineers aware of how to dispose of waste generated?

  • Does the the engineer have a copy of the Company's waste carriers license?

Core Gas safety

  • Can the Operative demonstrate/explain the correct isolation of the Gas supply/Explain the process needed

  • Is flue construction, route & termination satisfactory?

  • Are flue flow and continuity satisfactory?

  • What is the correct process to follow when carrying out a Spillage Test? (Demonstrate if possible)

  • Has ventilation been examined fully?

  • Can the Operative demonstrate/explain the process and procedure to follow when carrying out a commission?

  • What is the operating pressure?

  • What is the inlet working pressure?

  • Has the operative demonstrated a suitbale Gas Rate?

  • Flue Gas Analysis results (High)

  • Flue Gas Analysis Results (Low)

  • Have all Safety devices been checked for their suitable operation?

  • Have the case seals been inspected and tested?

  • Is the condensate termination suitable?

  • Is the PRV pipework suitbale?

  • Ask the following questions

  • When using an Electric Gauge, what is the perceptible movement?

  • When using a water Gauge, what is the perceptible movement?

  • Can you explain the stages of a tightness test, the pressures needed at each stage and the time frames used?

  • How would you confirm Let By and what actions would you take to confirm it?

  • Observe Operative undertaking Tightness Test in accordance with Company Policy and Current Legislation

  • Have all disturbed fittings/joints been tested?

  • Has the system been walked and bled?

  • Have all controls been tested?

  • Have any Unsafe Situations been identified?

Safe Electrical Isolation

  • Can you explain the process to follow when carrying out safe electrical isolation?

  • Can the Operative demonstrate Safe Electrical Isolation process in accordance to Company Procedure? *where applicable

  • Inspector - refer to attached Electrical Safety Training Presentation & Provide Training, obtain signoff

  • Following training given, I "The Operative" can confirm I have read, received and will adhere to all information provided

  • Has the fuse rating been checked?

Job Completion

  • Have the controls been reset and explained to the customer (if applicable)

  • Has the electronic device/Job sheet been fully updated?

  • Has the customer job sheet been completed (if applicable)

  • Has safety advice/warning notice been issued if necessary?

  • Have all warning labels been attached if applicable?

  • Has the appliance been turned off/capped if necessary?

Additional Questions

  • Ask 1 of the following questions

  • What are the minimum clearances when on a room-sealed flue outlet directly above, below or horizontally to an openable window/air brick?

  • What are the minimum clearances when on a room-sealed flue outlet horizontally from a terminal on the same wall?

  • What are the minimum clearances when on a room-sealed flue outlet below balconies or a carport roof?

Scenarios of AR/ID Situations

  • Ask 1 of the following questions

  • Outline the meaning of an Immediately Dangerous situation

  • Outline the meaning of an At-Risk situation

  • Ask 1 of the following questions

  • What would the following be categorised as? Where no work is undertaken on an appliance, but there are visual signs of spillage and/or leakage of combustion products and no evidence to support the problem has been rectified?

  • What would the following be categorised as? Let-by of any ECV/AECV without a smell of gas?

  • What would the following be categorised as? A flueless or non-room-sealed appliance in a room containing a bath or shower

  • What would the following be categorised as? An appliance (flued or flueless) with visual signs of incomplete combustion at a main burner and/or with in the main heat exchanger 1.) Flueless Appliance 2.) Flued appliance

Inspection Overview

  • Any remedials works or opportunity for improvement must be listed under Defects / Observations

  • Defects Identified / Observations

  • Recommendations / Comments

  • Gas Auditor Sign Off

  • Gas Operative Sign Off

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.