Gas Installation Inspection Form

• Gas inspection number

• Inspection type

  Select Compliance inspection Audit inspection Defect rectification inspection

  • Compliance inspection
  • Audit inspection
  • Defect rectification inspection
• Address
  Address

• Meter number

• Size

• Location

• Path valve locatable

  Yes

  No

  N/A

• Gas meter or boundary regulator in accessible location

  Yes

  No

  N/A

• Pipe work condition

  Good

  Fair

  Poor

  N/A

Unit inspection

• Unit number

  Select Unit 1 Unit 2 Unit 3 Unit 4 Unit 5 Unit 6 Unit 7 Unit 8 Unit 9 Unit 10 Unit 11 Unit 12 Unit 13 Unit 14 Unit 15 Unit 16 Unit 17 Unit 18 Unit 19 Unit 20 Unit 21 Unit 22 Unit 23 Unit 24 Unit 25 Unit 26 Unit 27 Unit 28 Unit 29 Unit 30

  • Unit 1
  • Unit 2
  • Unit 3
  • Unit 4
  • Unit 5
  • Unit 6
  • Unit 7
  • Unit 8
  • Unit 9
  • Unit 10
  • Unit 11
  • Unit 12
  • Unit 13
  • Unit 14
  • Unit 15
  • Unit 16
  • Unit 17
  • Unit 18
  • Unit 19
  • Unit 20
  • Unit 21
  • Unit 22
  • Unit 23
  • Unit 24
  • Unit 25
  • Unit 26
  • Unit 27
  • Unit 28
  • Unit 29
  • Unit 30

• Is gas available within this unit

  Yes

  No

  N/A

• What gas appliances are within the unit

  Select Cook top Gas oven Room heater flued Room heater unflued Gas bayonet point Storage water heater flued Storage water heater unflued (external) Instantaneous water heater flued Instantaneous water heater unflued (external) BBQ Other (provide description)

  • Cook top
  • Gas oven
  • Room heater flued
  • Room heater unflued
  • Gas bayonet point
  • Storage water heater flued
  • Storage water heater unflued (external)
  • Instantaneous water heater flued
  • Instantaneous water heater unflued (external)
  • BBQ
  • Other (provide description)

• Photo

  Media

• Photo

  Media

• Photo

  Media

• Photo

  Media

• Photo

  Media

• Photo

  Media

• Photo

  Media

• Photo

  Media

• Where is the meter located?

• Are gas appliances within the same area as the sleeping area of the unit?

  Yes

  No

• Do all appliances have an accessible isolation valve

  Yes

  No

  N/A

• Provide a photos of isolation valves

  Media

• Are all appliances in good working order

  Yes

  No

  N/A

• What appliances are not in good working order

  Select Cook top Gas oven Room heater flued Room heater unflued Gas bayonet point Storage water heater flued Storage water heater unflued (external) Instantaneous water heater flued Instantaneous water heater unflued (external) BBQ Other (provide description)

  • Cook top
  • Gas oven
  • Room heater flued
  • Room heater unflued
  • Gas bayonet point
  • Storage water heater flued
  • Storage water heater unflued (external)
  • Instantaneous water heater flued
  • Instantaneous water heater unflued (external)
  • BBQ
  • Other (provide description)

• Defect or non compliance within unit?

  Yes

  No

• What are the defects or non compliance issues?

Site summery

• Is the site safe

  Safe

  At Risk

  N/A

• What is not safe with the site?

  Yes

  No

  N/A

• Where all areas accessed?

  Yes

  No

  N/A

• What areas where not accessed?

• Inspection completed by

  Select

• Inspection performed on

  Date

• Signed

  Sign