Title Page

  • Site conducted

  • Site no

  • Conducted on

  • Prepared by

  • Location
  • Number of boilers on site

Gas Appliance

    Appliance details
  • Location of boiler

  • Make of boiler

  • Model of boiler

  • Boiler data badge

  • Photograph of appliance

  • Approx age of boiler (yrs)

  • Condition of boiler

  • Do you recommend the boiler should be replaced

  • Comments

  • Are there any more boilers onsite

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.