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?

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.