Information

  • Date

  • Contract Number

  • Client

  • Address
  • Engineer

  • Appliances

Van Checks

  • Tyres In Good Repair

  • Vehicle Clean and Tidy Mileage-

  • First Aid Kit

  • Fire Extinguisher

  • Spare / Surplus PPE

  • PAT Tested done

  • Ladder register

PPE

  • Uniform clean and tidy/knee pads/face mask

  • Safety boots/gloves/hardhat

  • Safety glasses/ear defenders

  • socket and see

  • Appliance
  • Type

  • Make/Model

  • Serial Number

  • G.C Number

Work Preparation & Customer Care

  • Gas Safe card on show

  • Company Uniform

  • Visual risk assessment e.g shoe covers, masks, dust sheets

  • Customer Contact

  • PoWRA Done

  • Customer care / work area preparation completed

Electrical isolation

  • Fluke pen used & tested

  • Fuse rating checked and appropriate

  • Electrical tests identified & completed correctly

Appliance Check

  • Appliance Installed to manufacturers instructions

  • Gas pipework size, support, construction, route correct

  • Pressure relief pipework / termination correct

  • Condensate pipework / termination correct

  • Flue size construction route termination and support visually examined and correct

  • Ventilation size and route checked and correct

  • Ancillary Plant installed correctly.

  • Systems configured correctly.

  • Appliance / associated controls operating correctly

  • Operating pressure and / or gas rate checked

  • Safety devices operation checked

  • Flame picture correct

  • Combustion analysis completed

  • Flue flow continuity check completed correctly

  • Spillage / Case seal tests completed correctly

  • Final tightness test completed correctly where required

  • All disturbed joints tested

Safe Working Practices

  • Safe working practices employed

  • Electrical equipment safety and calibration checks carried out.

Completion

  • Customer instructed in use and instructions left / controls reset

  • Documentation completed correctly

  • Underpinning Knowledge

Signatures

  • Auditor

  • Operative

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.