Title Page
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Client:
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Unit Number:
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Conducted on
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Gas Meter Reading:
Heater
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Make:
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Model:
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Serial Number:
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Gas Or Electric?
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Connection Type:
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Meets Australian Standards:
If "NO' fill in reason why:
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Reason For Not Meeting Standards?
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Repair Required?
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Priority To Repair:
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Picture of Appliances
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Further Information:
Bench Top Cooker
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Make:
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Model:
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Serial Number:
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Gas Or Electric?
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Connection Type:
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Meets Australian Standards:
If "NO' fill in reason why:
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Reason For Not Meeting Standards?
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Repair Required?
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Priority To Repair:
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Picture of Appliances
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Further Information:
Bench Top Oven
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Make:
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Model:
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Serial Number:
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Gas or Electric?
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Connection Type:
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Meets Australian Standards:
If "NO' fill in reason why:
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Reason For Not Meeting Standards?
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Repair Required?
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Priority To Repair:
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Picture of Appliances
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Further Information:
Hot Water Unit
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Make:
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Model:
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Serial Number:
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Gas Or Electric?
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Connection Type:
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Meets Australian Standards:
If "NO' fill in reason why:
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Reason For Not Meeting Standards?
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Repair Required?
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Priority To Repair:
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Picture of Appliances
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Further Information:
Other Information
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Any Other Information on Gas Appliances?
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Any Other Building Issues?
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Pictures of Building issues:
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Overall Meets Australian Standards?
