Heater

  • Make:

  • Model:

  • Serial Number:

  • Gas Or Electric?

  • Connection Type:

  • Meets Australian Standards:

  • If "NO' fill in reason why:
  • Reason For Not Meeting Standards?

  • Repair Required?

  • Priority To Repair:

  • Picture of Appliances

  • Further Information:

Bench Top Cooker

  • Make:

  • Model:

  • Serial Number:

  • Gas Or Electric?

  • Connection Type:

  • Meets Australian Standards:

  • If "NO' fill in reason why:
  • Reason For Not Meeting Standards?

  • Repair Required?

  • Priority To Repair:

  • Picture of Appliances

  • Further Information:

Bench Top Oven

  • Make:

  • Model:

  • Serial Number:

  • Gas or Electric?

  • Connection Type:

  • Meets Australian Standards:

  • If "NO' fill in reason why:
  • Reason For Not Meeting Standards?

  • Repair Required?

  • Priority To Repair:

  • Picture of Appliances

  • Further Information:

Hot Water Unit

  • Make:

  • Model:

  • Serial Number:

  • Gas Or Electric?

  • Connection Type:

  • Meets Australian Standards:

  • If "NO' fill in reason why:
  • Reason For Not Meeting Standards?

  • Repair Required?

  • Priority To Repair:

  • Picture of Appliances

  • Further Information:

Other Information

  • Any Other Information on Gas Appliances?

  • Any Other Building Issues?

  • Pictures of Building issues:

  • Overall Meets Australian Standards?

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