Information
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Date
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Contract Number
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Client
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Address
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Engineer
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Appliances
Van Checks
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Tyres In Good Repair
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Vehicle Clean and Tidy Mileage-
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First Aid Kit
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Fire Extinguisher
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Spare / Surplus PPE
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PAT Tested done
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Ladder register
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PPE
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Uniform clean and tidy/knee pads/face mask
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Safety boots/gloves/hardhat
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Safety glasses/ear defenders
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socket and see
Appliance
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Type
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Make/Model
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Serial Number
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G.C Number
Work Preparation & Customer Care
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Gas Safe card on show
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Company Uniform
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Visual risk assessment e.g shoe covers, masks, dust sheets
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Customer Contact
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PoWRA Done
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Customer care / work area preparation completed
Electrical isolation
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Fluke pen used & tested
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Fuse rating checked and appropriate
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Electrical tests identified & completed correctly
Appliance Check
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Appliance Installed to manufacturers instructions
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Gas pipework size, support, construction, route correct
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Pressure relief pipework / termination correct
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Condensate pipework / termination correct
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Flue size construction route termination and support visually examined and correct
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Ventilation size and route checked and correct
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Ancillary Plant installed correctly.
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Systems configured correctly.
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Appliance / associated controls operating correctly
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Operating pressure and / or gas rate checked
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Safety devices operation checked
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Flame picture correct
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Combustion analysis completed
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Flue flow continuity check completed correctly
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Spillage / Case seal tests completed correctly
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Final tightness test completed correctly where required
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All disturbed joints tested
Safe Working Practices
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Safe working practices employed
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Electrical equipment safety and calibration checks carried out.
Completion
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Customer instructed in use and instructions left / controls reset
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Documentation completed correctly
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Underpinning Knowledge
Signatures
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Auditor
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Operative