Information

  • Document No.

  • Audit Title

Customer / Job Details

  • Account Name

  • Postal Address

  • Name of Client

  • Site Address

  • Customer Description

  • Contact

  • Description of Job

  • Date Received

  • Date Started

  • Date Completed

  • Order Number

  • Quote/Estimate

  • Tax Invoice Number

  • Home

  • Work

  • Mobile

  • Mobile 2

  • Fax

  • Email

Customer Declaration (Optional)

  • I authorise this contractor to carry out the work as detailed on this form. I understand that no significant additional work will be undertaken without my authorisation and I accept the terms and conditions. I will settle payment by:

  • Customers Signature

Safety Verification, Pipework, Combustion Related Test

Safety Verification Of Gas System / Supply

  • Suitable Fittings

  • Available Flow Rate mj/hr

  • Drop Test kpa

  • Gas Tightness

  • Gas Pressure kpa

  • Meter

Pipework

  • Pressure Test

  • Pressure kpa

  • Installation Test kpa

Combustion Related Test

  • CO/CO2 %

  • Flue Temp 300 C

  • Ventilation

  • CO ppm

  • Flue Material C

  • Flue Condition

  • Gas appliance used for intended purpose

  • Reason

OSHE ~ Hazards Identifaction & Site Safety Requirements

  • Temperature - Climate Conditions

  • Action

  • Combustibles - Fire Resistant Material - Flammable Gas Signage

  • Action

  • Visitors - Induct all visitors & contractors with induction cards

  • Action

  • Moving Vehicles - Keep clear - Stay visible to operator - Signage

  • Action

  • Ladders - Only commercial grade in good condition - Used correctly

  • Action

  • Scaffolding - Installed correctly - Regularly checked - Certified

  • Action

  • Falls from height - Use fall protection - Scaffolding in place - Height notifiable work

  • Action

  • Overhead Work - Secure tools from falling - Visitors keep clear

  • Action

  • Electricity in use - Use RCD's - Check leads regularly - Tagged

  • Action

  • Powertools in use - Check in good condition - Use correctly - Tagged

  • Action

  • Excavations - Cover holes - Secure site - Stay visible to operator

  • Action

  • Tripa/Slipa - Keep site tidy - Use waste bin on site

  • Action

  • Illness/Disease - Toilet on site - Running water on site

  • Action

  • First Aid Certificate - Current - ABC's

  • Action

  • Gas Set/Mapp Gas - Oxygen - Acetylene - Shut off when not in use

  • Action

  • First Aid Kit - Upgraded - Where is it?

  • Action

Service Procedure

  • Isolate gas supply and/or electrical supply to the appliance

  • Remove gas control knobs and any panels from the gas appliance to gain access to gas valves, burners and pilot assembly

  • Clean inspirators primary air inlet Clean all openings from dust,spider webs etc.

  • Remove burner and clean all burner ports, check for corrosion

  • Remove pilot burner & clean both pilot injector and main burner injector

  • Reassemble both pilot burner and main burner

  • Visually check wires and electrical connections

  • Test all electrical safety interlocks for sound operation

  • Check ignitor probe for positioning and quick ignition

  • Check flame rectification probe for correct milliamp signal and positioning

  • Check thermocouple and/or thermopile for correct millivolt and positioning

  • Visually check flame picture and flame stability, check that aeration is correct

  • Check dynamic pressure and adjust if necessary

  • Leak test gas pipe work and controls for soundness

  • Which test did you use?

  • Check gas control valves for correct operation, physical damage and general wear and tear, clean any gas filters gauze or fabric

  • Ensure the draught diverter is clear of obstructions and check for draught using smoke while gas appliance is still cold

  • Check for condition of flue system and gas terminal to ensure that it has not been affected by any foreign or organic matter clear any flue blockage

  • Check the gas appliance position in relation to any combustible materials

  • Check room size for correct ventilation requirements against ASNZS 5601:2010

  • Ensure the room enclosure is not used to store flammable goods or chemicals, as flames will contaminate the combustion air and create toxic or deadly chemical reactions

  • Locate the date and ensure that the gas appliance is suitable for its intended use

  • Recommission the appliance in accordance with ASNZS 5601:2010

Gas Appliance Markings

  • Make

  • 1

  • 2

  • 3

  • 4

  • Model

  • 1

  • 2

  • 3

  • 4

  • Serial Number

  • 1

  • 2

  • 3

  • 4

  • Isolating Valve

  • 1

  • 2

  • 3

  • 4

  • Clearances

  • 1

  • 2

  • 3

  • 4

  • Flue Type

  • 1

  • 2

  • 3

  • 4

  • Flue Position

  • 1

  • 2

  • 3

  • 4

  • Appliance Pressure

  • 1

  • 2

  • 3

  • 4

  • Appliance Pressure High

  • 1

  • 2

  • 3

  • 4

  • Appliance Pressure Low

  • 1

  • 2

  • 3

  • 4

  • Input Rating

  • 1

  • 2

  • 3

  • 4

  • Commissioned

  • 1

  • 2

  • 3

  • 4

  • Ventilation

  • 1

  • 2

  • 3

  • 4

  • Combustion

  • 1

  • 2

  • 3

  • 4

  • Seismic Restraint

  • 1

  • 2

  • 3

  • 4

  • Date of Install

  • Gas Certification Number

  • Category

  • Type

  • Gas Supplier

  • Labelled

  • Test Pressure

  • Test Time

  • Nil Leak Tolerance

  • Regulators

  • Auto

  • Manual

  • LP-HP

  • First Stage

  • Second Stage

  • Appliance Reg

Ventilation Requirements

For further information see ASNZS 5601:2010, Ventilation requirements, parts 1 & 2 In brief: - Ventilation shall ensure proper operation of the gas appliance and flueing system and maintain safe ambient conditions - Where a gas appliance is installed in a room, that room shall be ventilated - Where the total input of open flued appliance exceeds 3MJ/hr for each cubic metre of room volume, the area shall be ventilated - Where the total input of open flued appliance does not exceed 3MJ/hr per cubic metre of room volume, the required air may be provided by adventitious openings, ie gaps around doors and windows - to establish whether the required air is to be provided by adventitious openings or additional openings. Calculate the total input of the gas appliance or appliance in the room in MJ/hr and divide by the room volume in cubic metres

  • Total gas input MJ/HR

  • Divided by

  • Room Volume m3 L x W x H

  • = m3

  • = MJ per cubic metre

Natural ventilation. Two permanent openings shall be provided each with a minimum free area as calculated using: A = FxT formula A = Minimum free area mm square F = Factor given in table 13 T = Total gas consumption of all gas appliances

  • Adventitious Ventilation

  • Additional Ventilation Required

  • Checked

  • Initials

Commissioning and Final Testing Checks (normal operating conditions)

  • Leak Test

  • OK

  • Comments

  • Gas Consumption

  • OK

  • Comments

  • Operation

  • OK

  • Comments

  • Reignition

  • OK

  • Comments

  • Flame Picture

  • OK

  • Comments

  • Temperature Hazards

  • OK

  • Comments

  • Safeguard System

  • OK

  • Comments

  • Safety Shut Down

  • OK

  • Comments

  • Visually Check Wires

  • OK

  • Comments

  • Earth Continuity Test 3 Volts less than 0.5 ohm

  • Comments

  • Insulation Resistance 500 Volts less than 1M ohm

  • Comments

  • Polarity Test

  • Comments

  • Troubleshooting and Fault Finding

  • Have you remedied the ...

  • What is the Root Cause of this failure or breakdown?

Completion of Work & Job Card

  • Signature of Technician

  • Date Signed

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