Existing concealed room-sealed fanned-draught boiler chimney assessment

• Document No.

• Gas Safe Registration number

• Gas Operative

• Operatives licence number

• Registered Business Details
  Address

• Occupants name

• Job Address
  Address

• Client/Landlord name

• Client/Landlords Details
  Address

• Date inspection carried out

  Date

Existing concealed room-sealed fanned-draught boiler chimney assessment

• This form should be completed in conjunction with Gas Safe Register Technical Bulletin 008 (Edition 3) dated 15 July 15:
  
  Existing concealed room-sealed fanned-draught boiler chimney/flue systems in domestic premises visit - www.gassaferegister.co.uk

• Is the chimney/flue system routed through adjacent property?

  Yes

  No

• Can access be gained to the adjacent property?

  Yes

  No

• Are there acceptable means to examine the entire chimney/flue system, i.e. inspection hatches installed?

  Yes

  No

• Subject to appropriate satisfactory operational safety checks in accordance with the manufacturer’s instructions and GSIUR 26(9), the boiler can be deemed safe and left operational.

• Gas Operatives signature

  Sign

• Is a Carbon Monoxide Safety shut-Off Void Monitoring (COSSVM) system installed? See Gas Safe Technical Bulletin 008 (Edition 3)<br><br>Note: Standard room monitoring CO alarms do not meet this criteria.

  Yes

  No

• Is the COSSVM installed and operating correctly?

  Yes

  No

• Subject to appropriate satisfactory operational safety checks in accordance with the manufacturer’s instructions and GSIUR 26(9), the boiler can be deemed safe and left operational.

• Gas Operatives signature

  Sign

• Classify as a 'AR' in accordance with the current Gas Industry Unsafe Situations Procedures carry out appropriate operational safety checks including combustion performance and confirm boiler is operating correctly. Affix appropriate warning label complete a warning/advice notice and with the permission of the responsible person turn off the boiler. Recommend the installation of CO alarms/protection equipment complies with BS EN 50291 and check the operation of any existing CO alarms.
  
  I confirm that the assessment has been undertaken and the results have been brought to the attention of the responsible person in accordance with the gas safety installation and use regulations, industry standards and procedures

• Gas Operatives signature

  Sign

• DEFINITION
  'AT RISK' (AR) Appliances/Installations - An 'AR' appliance/installation is one which, if operated may lead to a situation which could CREAT RISK to life or property

• Does the ceiling/enclosure indicate any signs of distress along the route of the chimney/flue system which cannot be attributed to other causes, e.g. water leaks etc?

  Yes

  No

• Classify as 'ID' in accordance with current Gas Industry Unsafe Situations Procedures. Affix appropriate warning label and complete a Warning/Advice Notice. With permission of the responsible person. disconnect and seal the gas supply to the boiler with an appropriate fitting. Complete an online RIDDOR 6(2) report http://www.hse.gov.uk/riddor.
  
  I confirm that the assessment has been undertaken and the results have been brought to the attention of the responsible person in accordance with the Gas Safety (Installation and Use) Regulations, Industry Standards and Procedures.
  https://extranet.hse.gov.uk/lfserver/external/F2508G2E

• Gas Operatives signature

  Sign

• DEFINITION
  'IMMEDIATELY DANGEROUS' (ID) Appliances/Installations - An 'ID' appliance/installation is one which, if operated or left connected to a gas supply, is an IMMEDIATE danger to life or property.

• Classify as a 'AR' in accordance with the current Gas Industry Unsafe Situations Procedures carry out appropriate operational safety checks including combustion performance and confirm boiler is operating correctly. Affix appropriate warning label complete a warning/advice notice and with the permission of the responsible person turn off the boiler. Recommend the installation of CO alarms/protection equipment complies with BS EN 50291 and check the operation of any existing CO alarms.
  
  I confirm that the assessment has been undertaken and the results have been brought to the attention of the responsible person in accordance with the gas safety installation and use regulations, industry standards and procedures

• Gas Operatives signature

  Sign

• DEFINITION
  'AT RISK' (AR) Appliances/Installations - An 'AR' appliance/installation is one which, if operated may lead to a situation which could CREAT RISK to life or property

• Take all 'reasonable steps' to verify overall chimney/flue system integrity e.g. by;
  
  Attempting to gain access
  Arranging access with the responsible person for the building.
  
  Where access cannot be gained provide relevant address information to Gas Safe’s ‘Flues In Voids’ database. https://engineers.gassaferegister.co.uk/fluesinvoids.aspx.

• Does evidence exist indicating any historical issues relating to concealed chimney/flue within the building/development and with no evidence of subsequent remedial action to correct the issue?

  Yes

  No

• Does evidence constitute an immediate danger?

  Yes

  No

• Classify as 'ID' in accordance with current Gas Industry Unsafe Situations Procedures. Affix appropriate warning label and complete a Warning/Advice Notice. With permission of the responsible person. disconnect and seal the gas supply to the boiler with an appropriate fitting. Complete an online RIDDOR 6(2) report www.hse.gov.uk/riddor.
  
  I confirm that the assessment has been undertaken and the results have been brought to the attention of the responsible person in accordance with the Gas Safety (Installation and Use) Regulations, Industry Standards and Procedures.
  https://extranet.hse.gov.uk/lfserver/external/F2508G2E

• Gas Operatives signature

  Sign

• DEFINITION
  'IMMEDIATELY DANGEROUS' (ID) Appliances/Installations - An 'ID' appliance/installation is one which, if operated or left connected to a gas supply, is an IMMEDIATE danger to life or property.

• Classify as a 'AR' in accordance with the current Gas Industry Unsafe Situations Procedures carry out appropriate operational safety checks including combustion performance and confirm boiler is operating correctly. Affix appropriate warning label complete a warning/advice notice and with the permission of the responsible person turn off the boiler. Recommend the installation of CO alarms/protection equipment complies with BS EN 50291 and check the operation of any existing CO alarms.
  
  I confirm that the assessment has been undertaken and the results have been brought to the attention of the responsible person in accordance with the gas safety installation and use regulations, industry standards and procedures

• Gas Operatives signature

  Sign

• DEFINITION
  'AT RISK' (AR) Appliances/Installations - An 'AR' appliance/installation is one which, if operated may lead to a situation which could CREAT RISK to life or property

• Provided that; from what can be determined from the parts of the installation that can be examined and where there is NO evidence that the concealed chimney/flue system is otherwise unsafe the boiler can be reasonably considered safe and left operational.
  
  Subject to appropriate and satisfactory operational checks in accordance with manufacturer’s instructions and GSIUR 26(9).

• Gas Operatives signature

  Sign

• Are there acceptable means to examine the entire chimney/flue system, i.e. inspection hatches installed?

  Yes

  No

• Subject to appropriate satisfactory operational safety checks in accordance with the manufacturer’s instructions and GSIUR 26(9), the boiler can be deemed safe and left operational.

• Gas Operatives signature

  Sign

• Is a Carbon Monoxide Safety Shut-Off Void Monitoring (COSSVM) system installed? See Gas Safe Technical Bulletin 008 (Edition 3)<br><br>Note: Standard room monitoring CO alarms do not meet this criteria.

  Yes

  No

• Is the COSSVM installed and operating correctly?

  Yes

  No

• Subject to appropriate satisfactory operational safety checks in accordance with the manufacturer’s instructions and GSIUR 26(9), the boiler can be deemed safe and left operational.

• Gas Operatives signature

  Sign

• Classify as a 'AR' in accordance with the current Gas Industry Unsafe Situations Procedures carry out appropriate operational safety checks including combustion performance and confirm boiler is operating correctly. Affix appropriate warning label complete a warning/advice notice and with the permission of the responsible person turn off the boiler. Recommend the installation of CO alarms/protection equipment complies with BS EN 50291 and check the operation of any existing CO alarms.
  
  I confirm that the assessment has been undertaken and the results have been brought to the attention of the responsible person in accordance with the gas safety installation and use regulations, industry standards and procedures

• Gas Operatives signature

  Sign

• DEFINITION
  'AT RISK' (AR) Appliances/Installations - An 'AR' appliance/installation is one which, if operated may lead to a situation which could CREAT RISK to life or property

• Does the ceiling/enclosure indicate any signs of distress along the route of the chimney/flue system which cannot be attributed to other causes, e.g. water leaks etc?

  Yes

  No

• Classify as 'ID' in accordance with current Gas Industry Unsafe Situations Procedures. Affix appropriate warning label and complete a Warning/Advice Notice. With permission of the responsible person. disconnect and seal the gas supply to the boiler with an appropriate fitting. Complete an online RIDDOR 6(2) report www.hse.gov.uk/riddor.
  
  I confirm that the assessment has been undertaken and the results have been brought to the attention of the responsible person in accordance with the Gas Safety (Installation and Use) Regulations, Industry Standards and Procedures.
  https://extranet.hse.gov.uk/lfserver/external/F2508G2E

• Gas Operatives signature

  Sign

• DEFINITION
  'IMMEDIATELY DANGEROUS' (ID) Appliances/Installations - An 'ID' appliance/installation is one which, if operated or left connected to a gas supply, is an IMMEDIATE danger to life or property.

• Classify as a 'AR' in accordance with the current Gas Industry Unsafe Situations Procedures carry out appropriate operational safety checks including combustion performance and confirm boiler is operating correctly. Affix appropriate warning label complete a warning/advice notice and with the permission of the responsible person turn off the boiler. Recommend the installation of CO alarms/protection equipment complies with BS EN 50291 and check the operation of any existing CO alarms.
  
  I confirm that the assessment has been undertaken and the results have been brought to the attention of the responsible person in accordance with the gas safety installation and use regulations, industry standards and procedures

• Gas Operatives signature

  Sign

• DEFINITION
  'AT RISK' (AR) Appliances/Installations - An 'AR' appliance/installation is one which, if operated may lead to a situation which could CREAT RISK to life or property

• Notes