Information

  • Work order No. - Engineers name

  • Engineer name

  • Conducted on

  • Prepared by

  • Location

Engineer

  • Employed by ?

  • If Sub Contractor - identify company

  • Engineer name

  • Engineer picture

  • Gas safe card in date<br>(picture both sides)

Work activity & gas types (Tick all applicable)

  • undefined

Documentation

  • CP15 - Plant commissioning servicing record (non domestic)

  • CP1 - Gas Safety Record

  • Gas safety certificate<br>(Domestic landlords certificate)

  • CP4 - Gas Safety Inspection

  • Warning advice notice

  • Gas testing purging non domestic

  • Appliance history sticker

  • The gas industry unsafe situations procedure - Current Edition

  • Warning labels immediately dangerous

  • Warning label at risk

  • GID1 - Gas safe essential gas safety manual - domestic or equivalent

  • ND1 - Gas safe essential gas - commercial natural gas handbook or equivalent

Hand Tools

  • Tool box/bag cleaning

  • Tool box/bag safe and secure

  • Hand tools clean

  • Hand tools safe and fit for purpose

  • Manometer & tube

  • Leak detector fluid

  • Smoke matches

  • Smoke pellets

  • Gas marking tape

  • Earth bonding strap

  • Stop watch

  • Calibrated combustion analyser with printer

  • Make

  • Add media

  • Model number

  • Add media

  • Serial number

  • Add media

  • Calibration number

  • Add media

  • Calibration expires

  • Capping off equipment

  • Appliance
    (Take picture)

  • Appliance (Take picture)
  • Make

  • Add media

  • Model number

  • Add media

  • Location

Is the appliance and / or installation safe to use?

  • Appliance
    (Take picture)

  • Appliance (Take picture)
  • Select category - if RIDDOR register with gas safe immediately

  • If any of the above are not N/A has appropriate warning notice been raised

Defects

  • To be rectified by engineer

General comments and observations

  • Noted by auditor

  • Do you understand your Gas safe requirements. e.g. <br>1. Obtaining manufacturers servicing & installation instructions.<br>2. Gas safe site login to notify new installs and unsafe conditions.

Sign off audit

  • Engineer signature

  • Auditor signature

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