AJK Gas Installation Report

• Customer Name

• Address

• Property Type

  Select Flat Semi-Detached Terraced End of Terrace Bungalow Detached

  • Flat
  • Semi-Detached
  • Terraced
  • End of Terrace
  • Bungalow
  • Detached

• Contact Details

• Installation work

  Select Full Heating Conversion Combi Swap

  • Full Heating
  • Conversion
  • Combi Swap

Exisiting Boiler

• Make

• Model

• Boiler Type Removed

  Select Gas Open Flue Cast Iron Gas Open Flue Low Water Content Gas Room Sealed Cast Iron Gas Room Sealed Low Water Content

  • Gas Open Flue Cast Iron
  • Gas Open Flue Low Water Content
  • Gas Room Sealed Cast Iron
  • Gas Room Sealed Low Water Content

• Installer commissioning Engineer Details

• Gas Safe number and serial number

Gas Tightness Test

• Initial Gas Test start of job/Pressure drop mb

• Final Test (Completion) Pressure drop mb

• Appliances worked on

Appliance

• Appliance type

  Select Boiler Fire Cooker BBU Wather Heater Tumble Drier Other

  • Boiler
  • Fire
  • Cooker
  • BBU
  • Wather Heater
  • Tumble Drier
  • Other

• Maunfacturer

  Select Other Valliant Worcester Potterton Ideal Glow Worm Baxi Biasi Belling Cannon Valour

  • Other
  • Valliant
  • Worcester
  • Potterton
  • Ideal
  • Glow Worm
  • Baxi
  • Biasi
  • Belling
  • Cannon
  • Valour

• Model

  Select Other Ecotec 2Pro 24HE Ecotec 2Pro 28HE Ecotec 2Plus 831 HE Ecotec Plus 415 Ecotec Plus 418 Ecotec Plus 428 Ultracom 2 12SXI Ultracom 2 18SXI Promax 28HE Promax 33HE PMAX 12 HE SYS PAMX 18 HE SYS PMAX 24 HE SYS PMAX 12 HE SL PMAX 18 HE SL PAMX 24 HE SL Junior 28i Bermuda Braziler Country Chef Canterbury Logic Combi 30

  • Other
  • Ecotec 2Pro 24HE
  • Ecotec 2Pro 28HE
  • Ecotec 2Plus 831 HE
  • Ecotec Plus 415
  • Ecotec Plus 418
  • Ecotec Plus 428
  • Ultracom 2 12SXI
  • Ultracom 2 18SXI
  • Promax 28HE
  • Promax 33HE
  • PMAX 12 HE SYS
  • PAMX 18 HE SYS
  • PMAX 24 HE SYS
  • PMAX 12 HE SL
  • PMAX 18 HE SL
  • PAMX 24 HE SL
  • Junior 28i
  • Bermuda
  • Braziler
  • Country Chef
  • Canterbury
  • Logic Combi 30

• Location of Appliance

  Select Other Kitchen Bathroom Compartment Livingroom Lounge Bedroom Hall Utillity Room Out House

  • Other
  • Kitchen
  • Bathroom
  • Compartment
  • Livingroom
  • Lounge
  • Bedroom
  • Hall
  • Utillity Room
  • Out House

• Flue Type

  Select Room Sealed Fanned Room Sealed Natural draft Open Flue Flueless Other

  • Room Sealed Fanned
  • Room Sealed Natural draft
  • Open Flue
  • Flueless
  • Other

• Flue installation satisfactory

  Yes

  No

  N/A

• Ventilation Satisfactory

  Yes

  No

  N/A

• Safety Labels fitted

  Yes

  No

  N/A

• Burner Pressure mb if required by Manufacturer

• Gas Rate Kw

• Flue Check OK

  Yes

  No

  N/A

• Spillage Check OK

  Yes

  No

  N/A

• Please supply the combusion readings of appliance at max CO ppm

• If required CO2% Max Rate

• Please enter CO/CO2 Ratio at max rate

• Please supply the combustion readings of appliances at min rate CO PPM

• If required CO2% Min Rate

• Please enter CO/CO2 ratio at Min Rate

• GC Number

• Serial Number

• Picture of data badge if required

  Media

• Appliance Staus

  Select Safe Immediately Dangerous At Risk Not to Current Standards

  • Safe
  • Immediately Dangerous
  • At Risk
  • Not to Current Standards

If appliance is already in this status refer to warning notice left by installer if changing status issue notices and leave as per current Gas Regulations

List all appliances relit and / or purged (following Operational procedures if defect identified)

Additional appliances relit/purged

• Appliance Type

  Select Boiler Fire Cooker BBU Wather Heater Tumble Drier Other

  • Boiler
  • Fire
  • Cooker
  • BBU
  • Wather Heater
  • Tumble Drier
  • Other

• Manufacturer

  Select Other Valliant Worcester Potterton Ideal Glow Worm Baxi Biasi Belling Cannon Valour

  • Other
  • Valliant
  • Worcester
  • Potterton
  • Ideal
  • Glow Worm
  • Baxi
  • Biasi
  • Belling
  • Cannon
  • Valour

• Model

  Select Other Ecotec 2Pro 24HE Ecotec 2Pro 28HE Ecotec 2Plus 831 HE Ecotec Plus 415 Ecotec Plus 418 Ecotec Plus 428 Ultracom 2 12SXI Ultracom 2 18SXI Promax 28HE Promax 33HE PMAX 12 HE SYS PAMX 18 HE SYS PMAX 24 HE SYS PMAX 12 HE SL PMAX 18 HE SL PAMX 24 HE SL Junior 28i Bermuda Braziler Country Chef Canterbury Logic Combi 30

  • Other
  • Ecotec 2Pro 24HE
  • Ecotec 2Pro 28HE
  • Ecotec 2Plus 831 HE
  • Ecotec Plus 415
  • Ecotec Plus 418
  • Ecotec Plus 428
  • Ultracom 2 12SXI
  • Ultracom 2 18SXI
  • Promax 28HE
  • Promax 33HE
  • PMAX 12 HE SYS
  • PAMX 18 HE SYS
  • PMAX 24 HE SYS
  • PMAX 12 HE SL
  • PMAX 18 HE SL
  • PAMX 24 HE SL
  • Junior 28i
  • Bermuda
  • Braziler
  • Country Chef
  • Canterbury
  • Logic Combi 30

• Location

  Select Other Kitchen Bathroom Compartment Livingroom Lounge Bedroom Hall Utillity Room Out House

  • Other
  • Kitchen
  • Bathroom
  • Compartment
  • Livingroom
  • Lounge
  • Bedroom
  • Hall
  • Utillity Room
  • Out House

• Appliance condition

  Select Good Bad Under 5 years old Over 5 years old Over 10 years old Over 15 years old Over 20 years old

  • Good
  • Bad
  • Under 5 years old
  • Over 5 years old
  • Over 10 years old
  • Over 15 years old
  • Over 20 years old

• Flue Type

  Select Room Sealed Fanned Room Sealed Natural draft Open Flue Flueless Other

  • Room Sealed Fanned
  • Room Sealed Natural draft
  • Open Flue
  • Flueless
  • Other

• Is flue correct

  Yes

  No

  N/A

• Ventilation satisfactory

  Yes

  No

  N/A

• Installation/General stabillity Clearances Etc

  Yes

  No

  N/A

• Overall Rating of appliance /installation

  Safe free from obvious defects

  Not to current standards

  At Risk

  Immediately Dangerous

Additional Information

• Installer/Engineer

  Sign