Commercial/Domestic Service Job Card CV1

• Document No.

• Audit Title

• Account Name

• Postal Address

• Name of Client

• Site Address

• Customer Description

• Contact

• Description of Job

• Date Received

  Date

• Date Started

  Date

• Date Completed

  Date

• Order Number

• Quote/Estimate

  Quote

  Estimate

• Tax Invoice Number

• Home

• Work

• Mobile

• Mobile 2

• Fax

• Email

• 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:

  Cash

  Eftpos

  Account

  MasterCard

  Visa

• Customers Signature

  Sign

Safety Verification Of Gas System / Supply

• Suitable Fittings

  Yes

  No

• Available Flow Rate mj/hr

• Drop Test kpa

• Gas Tightness

  Fail

  Pass

• Gas Pressure kpa

• Meter

Pipework

• Pressure Test

  Fail

  Pass

  N/A

• Pressure kpa

• Installation Test kpa

Combustion Related Test

• CO/CO2 %

• Flue Temp 300 C

  Yes

  No

  Not Tested

• Ventilation

• CO ppm

• Flue Material C

• Flue Condition

• Gas appliance used for intended purpose

  Yes

  No

• Reason

• 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

• 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?

  Drop test

  Spy glass

  Leak detector

• 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

• 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

  Date

• Gas Certification Number

• Category

  Commercial

  Domestic

  Mobile

  Temporary

• Type

  Service

  New

  Alteration

  Addition

  Replacement

• Gas Supplier

• Labelled

• Test Pressure

• Test Time

• Nil Leak Tolerance

• Regulators

• Auto

• Manual

• LP-HP

• First Stage

• Second Stage

• Appliance Reg

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

  Yes

  No

• Additional Ventilation Required

  Yes

  No

• Checked

• Initials

  Sign

• 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

  P

  N

  E

• Comments

• Troubleshooting and Fault Finding

• Have you remedied the ...

  Root Cause

  Cause

  Effect

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

• Signature of Technician

  Sign

• Date Signed

  Date