Gas Safety Check
-
This inspection is for gas safety purposes only and is in accordance with the requirements of the Residential Tenancies Regulations 2021 and the Residential Tenancies ( Rooming House Standards) Regulations 2012
Gasfitter contact details
-
Address of Installation
-
Inspection date:
-
Next Inspection due by:
-
License/REC
-
Name
undefined
-
Note: It is an offence to perform Type A gas appliance servicing work without the required qualifications (refer to the Plumbing Regulations)
House Gas Test
Installation Check - Appliance 1
-
Add media
-
Is the installation gastight in accordance with AS/NZS5601.1
-
Is the appliance and its components accessible for servicing and adjustment
-
Where required by AS/NZS5601.1 is an isolation valve provided at the inlet connection of the appliance
-
Is the appliance and its installation electrically safe (NOTE - Electrical safety is confirmed by checking the electrical supply is isolated, checking earth continuity, checking insulation resistance (where applicable) and using bonding straps if disconnecting an appliance)
-
Is there evidence of certification (AGA,SAI-Global, IAPMO, Global-Mark or BSI) (Record in the observations table if there is no evidence of certification)
-
Where applicable are gas appliances including cookers adequately restrained from tipping over
-
Is the room ventilation adequate for the installed appliance (consider installation and building date for applicable requirements)
-
Where visible are clearances from combustible surfaces in accordance with the installation instructions and AS/NZS5601.1
-
Where applicable is the cowl, chimney plate or flue terminal in good condition and clear of obstructions
-
Where applicable is the flue adequately supported and correctly installed (i.e. terminal has correct clearance distance) and sealed at roof penetration
-
Where applicable is the flue, or its surroundings, clear of signs of scorching or overheating
Appliance Servicing (for guidance on servicing Type A gas appliances refer to AS4575)
-
Where applicable is the heat exchanger in good condition (test for spillage of combustion products)
-
Has the appliance been cleaned of dust and debris (e.g. burner, pilot, fan, filters, air intake)
-
Are gas supply and burner operating pressures correct (Note - All appliances must be operating)
-
Is the appliance clean of dust and debris (e.g. burner, pilot, fan, filters, air intake)
-
Are burner flames normal (i.e. no evidence of flame lifting, floating, yellow tipping or sooting)
-
Is the appliance operating correctly including safety devices such as pressure and temperature relief valves
House Gas Test
Installation Check - Appliance 2
-
Add media
-
Is the installation gastight in accordance with AS/NZS5601.1
-
Is the appliance and its components accessible for servicing and adjustment
-
Where required by AS/NZS5601.1 is an isolation valve provided at the inlet connection of the appliance
-
Is the appliance and its installation electrically safe (NOTE - Electrical safety is confirmed by checking the electrical supply is isolated, checking earth continuity, checking insulation resistance (where applicable) and using bonding straps if disconnecting an appliance)
-
Is there evidence of certification (AGA,SAI-Global, IAPMO, Global-Mark or BSI) (Record in the observations table if there is no evidence of certification)
-
Where applicable are gas appliances including cookers adequately restrained from tipping over
-
Is the room ventilation adequate for the installed appliance (consider installation and building date for applicable requirements)
-
Where visible are clearances from combustible surfaces in accordance with the installation instructions and AS/NZS5601.1
-
Where applicable is the cowl, chimney plate or flue terminal in good condition and clear of obstructions
-
Where applicable is the flue adequately supported and correctly installed (i.e. terminal has correct clearance distance) and sealed at roof penetration
-
Where applicable is the flue, or its surroundings, clear of signs of scorching or overheating
Appliance Servicing (for guidance on servicing Type A gas appliances refer to AS4575)
-
Where applicable is the heat exchanger in good condition (test for spillage of combustion products)
-
Has the appliance been cleaned of dust and debris (e.g. burner, pilot, fan, filters, air intake)
-
Are gas supply and burner operating pressures correct (Note - All appliances must be operating)
-
Is the appliance clean of dust and debris (e.g. burner, pilot, fan, filters, air intake)
-
Are burner flames normal (i.e. no evidence of flame lifting, floating, yellow tipping or sooting)
-
Is the appliance operating correctly including safety devices such as pressure and temperature relief valves
House Gas Test
Installation Check - Appliance 3
-
Add media
-
Is the installation gastight in accordance with AS/NZS5601.1
-
Is the appliance and its components accessible for servicing and adjustment
-
Where required by AS/NZS5601.1 is an isolation valve provided at the inlet connection of the appliance
-
Is the appliance and its installation electrically safe (NOTE - Electrical safety is confirmed by checking the electrical supply is isolated, checking earth continuity, checking insulation resistance (where applicable) and using bonding straps if disconnecting an appliance)
-
Is there evidence of certification (AGA,SAI-Global, IAPMO, Global-Mark or BSI) (Record in the observations table if there is no evidence of certification)
-
Where applicable are gas appliances including cookers adequately restrained from tipping over
-
Is the room ventilation adequate for the installed appliance (consider installation and building date for applicable requirements)
-
Where visible are clearances from combustible surfaces in accordance with the installation instructions and AS/NZS5601.1
-
Where applicable is the cowl, chimney plate or flue terminal in good condition and clear of obstructions
-
Where applicable is the flue adequately supported and correctly installed (i.e. terminal has correct clearance distance) and sealed at roof penetration
-
Where applicable is the flue, or its surroundings, clear of signs of scorching or overheating
Appliance Servicing (for guidance on servicing Type A gas appliances refer to AS4575)
-
Where applicable is the heat exchanger in good condition (test for spillage of combustion products)
-
Has the appliance been cleaned of dust and debris (e.g. burner, pilot, fan, filters, air intake)
-
Are gas supply and burner operating pressures correct (Note - All appliances must be operating)
-
Is the appliance clean of dust and debris (e.g. burner, pilot, fan, filters, air intake)
-
Are burner flames normal (i.e. no evidence of flame lifting, floating, yellow tipping or sooting)
-
Is the appliance operating correctly including safety devices such as pressure and temperature relief valves
House Gas Test
Installation Check - Appliance 4
-
Add media
-
Is the installation gastight in accordance with AS/NZS5601.1
-
Is the appliance and its components accessible for servicing and adjustment
-
Where required by AS/NZS5601.1 is an isolation valve provided at the inlet connection of the appliance
-
Is the appliance and its installation electrically safe (NOTE - Electrical safety is confirmed by checking the electrical supply is isolated, checking earth continuity, checking insulation resistance (where applicable) and using bonding straps if disconnecting an appliance)
-
Is there evidence of certification (AGA,SAI-Global, IAPMO, Global-Mark or BSI) (Record in the observations table if there is no evidence of certification)
-
Where applicable are gas appliances including cookers adequately restrained from tipping over
-
Is the room ventilation adequate for the installed appliance (consider installation and building date for applicable requirements)
-
Where visible are clearances from combustible surfaces in accordance with the installation instructions and AS/NZS5601.1
-
Where applicable is the cowl, chimney plate or flue terminal in good condition and clear of obstructions
-
Where applicable is the flue adequately supported and correctly installed (i.e. terminal has correct clearance distance) and sealed at roof penetration
-
Where applicable is the flue, or its surroundings, clear of signs of scorching or overheating
Appliance Servicing (for guidance on servicing Type A gas appliances refer to AS4575)
-
Where applicable is the heat exchanger in good condition (test for spillage of combustion products)
-
Has the appliance been cleaned of dust and debris (e.g. burner, pilot, fan, filters, air intake)
-
Are gas supply and burner operating pressures correct (Note - All appliances must be operating)
-
Is the appliance clean of dust and debris (e.g. burner, pilot, fan, filters, air intake)
-
Are burner flames normal (i.e. no evidence of flame lifting, floating, yellow tipping or sooting)
-
Is the appliance operating correctly including safety devices such as pressure and temperature relief valves
LP Gas
LP Gas cylinder and associated components (where applicable)
-
Are cylinders installed on a firm, level and non-combustible base, and not resting on soil
-
Are LP Gas cylinders suitable restrained and have compliant clearances
-
Are hoses, pigtail and fittings in good condition and not degraded or work hardened
-
Are pressure regulators correctly fitted, orientated, set and complete
Combustion spillage from open flued and room sealed appliances
-
Refer to ESV Gas Information Sheet 38 and AS 4575)
-
Before proceeding with combustion product spillage testing ensure the appliance is clean and operating in accordance with the manufactures requirements. Combustion products readings should be recorded in the observation table
Appliance 1
-
Add media
-
Location
-
Type
-
Make
-
Model
-
Negative pressure test (open flued appliances only) - Was there a negative pressure
-
Spillage test - Was there spillage of combustion products
Appliance 2
-
Add media
-
Location
-
Type
-
Make
-
Model
-
Negative pressure test (open flued appliances only) - Was there a negative pressure
-
Spillage test - Was there spillage of combustion products
Appliance 3
-
Add media
-
Location
-
Type
-
Make
-
Model
-
Negative pressure test (open flued appliances only) - Was there a negative pressure
-
Spillage test - Was there spillage of combustion products
Dangerous gas installation
-
Gas Safety (Gas Installation) Regulations 2018, Part 3, Division 3, section 21
-
1. If a person carrying out gas fitting work on a gas installation becomes aware of a danger arising from a defect in the gas installation, the person must without delay - a) take all steps that are necessary to make the installation safe; and b) notify the owner of the gas installation and the occupier of the premises in which the installation is situated of the defect
2. Sub regulation (1)(a) does not apply if the person is unable, or it is unreasonable for the person, to take the necessary steps to make the gas installation safe
3. If the person carrying out the gas fitting work is unable, or it is unreasonable for the person, to make the gas installation safe, he or she must, without delay, notify Energy Safe Victoria and - a) If the gas installation uses natural gas, the gas distribution company which supplies that gas to the gas installation of the defect; or b) If the gas installation uses LPG, the gas retailer which supplies that gas to the gas installation of the defect
Observations and identification of faults
-
Details of observations and identified faults Note: Include reference to a Compliance Certificate number if applicable
Declaration
-
I, being the person responsible for the inspection of the identified gas appliances or installations in the rental property or rooming house, particulars of which are described here, having exercised reasonable skill and care when carrying out the inspection, hereby declare on the date of inspection that the information in this report, including the observations and recommendations, provides an accurate assessment of the condition of the gas appliances and installations in the rental property and rooming house taking into account the stated extent of the installation and the limitations of the inspection and testing
-
I further declare that in my judgement, the said appliance(s) and corresponding installation(s) is/are <br> Compliant - gas appliance or gas installation complies with the criteria far a "gas safety check" in the residential tenancies regulations <br> <br>Non Compliant - no immediate risk, however the customer should be advised that remedial work is required to be carried out to bring the gas appliance or its installation up to standard <br> Unsafe - gas appliance or its installation is unsafe and requires disconnection and urgent work as the safety of person be at risk or there may be damage to property
-
Add signature
