Emh Gas
Audit details
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Job Reference Number
Operatives Name
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Auditor
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Location
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Gas Safe Registration number
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Gas Safe Licence number
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Work Type
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Contract
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Audit type
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Conducted on
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Date work carried out
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Copy of LGSR that has been audited against
Appliances
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Appliance
Appliance Details
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Appliance Type
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Photo of appliance
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Flue type
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Make
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Model
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Landlords Appliance
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Location
- Kitchen
- Utility room
- Lounge
- Bedroom
- Bathroom
- Hall
- Loft
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Type of inspection
Appliance checks
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1) Flue route / construction / support / termination
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2) Ventilation size / configuration
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Add media
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3) Appliance installed to manufacturers instructions
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Add media
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4) Appliance controls and operation
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undefined
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Add media
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5) Fuse rating checked
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undefined
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Add media
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6) Appliance cleaned / inspected
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undefined
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Add media
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7) Flue operational and visual checks
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undefined
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Add media
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8) Safety device operation
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undefined
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Add media
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9) Burner pressure /Rated input
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undefined
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Add media
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Inlet pressure Mbar =
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Operating pressure Mbar =
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NET INPUT kWh =
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10) Flue integrity
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Add media
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FGA readings High CO2%/COppm/Ratio
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FGA readings Low CO2%/COppm/Ratio
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Add media
Pipework and meter installation
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11) Meter installation / ECV / Labels
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12) Tightness test / LDF used in disturbed joints
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undefined
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Add media
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13) Visual inspection of pipework
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undefined
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Add media
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14) MEB (bonding) Correctly positioned?
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undefined
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Add media
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Working pressure Mbar =
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Comments
Unsafe situations
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15) Unsafe situations correctly identified
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Add media
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16) Warning label attached / notice issued
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Add media
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17) Installation left safe to use?
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Add media
Smoke Detectors.
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Make
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Type
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Expiry date
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Location
- Kitchen
- Utility room
- Lounge
- Bedroom
- Bathroom
- Hall
- Loft
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Tested
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Comments
Carbon Monoxide Detector
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Make
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Type
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Expiry date
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Location
- Kitchen
- Utility room
- Lounge
- Bedroom
- Bathroom
- Hall
- Loft
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Tested
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Comments
Work and Documentation
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18) Has the work been correctly completed?
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Add media
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Missing information
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19) Are the appliances/ installation safe to use?
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undefined
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Add media
WIP
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20) Customer liaison / interaction.
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Comments
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Add media
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Are you satisfied with the quality of work undertaken?
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Comments
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21) Did the operative work in a safe manner?
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Comments
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Add media
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22) Protection of customers property (e.g. Dust sheets used)
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Comments
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Add media
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23) I.D. / Licence card shown
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Add media
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24) Operative carries relevant reference material
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undefined
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Add media
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25) Safe isolation carried out
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undefined
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Add media
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27) Engineer has relevant tools and equipment
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undefined
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Add media
Scores and outcome
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Has a copy of the Landlord Gas Safety Record been left with the resident?
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Confirm all questions answered.
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Overall outcome
- Above 90% = PASS
- Between 70 and 89% = Corrective action required
- Below 69% = unsatisfactory
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OPERATIVE SIGNATURE (WIP only)
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AUDITORS SIGNATURE
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Corrective action information
Corrective action
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Who will be involved in closing the corrective action
- Operative
- Line Manager
- RGTA
- National Compliance Manager
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What are the recommendations
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What actions have been implemented
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What is the target date to close the corrective action
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Operative signature confirming action implemented is understood
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Auditors Signature
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Corrective actions to be completed within the time specified or reason for non completion before specified time to be reported to RGTA. Completed corrective action to be sent back to issuing RGTA with supporting evidence where required, RGTA to close corrective action on monitoring system when satisfied appropriate action has been carried out.
