Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Information

  • Date

  • Name and address of customer

Appliance

  • Type of appliance

  • Make & model

  • Flue type

  • Visual condition/termination of appliance/flue satisfactory

  • Flue flow test satisfactory

  • Spillage test satisfactory

  • Appliance safe to use

  • Condition/efficiency , 0 = poor 10 = excellent

  • Recommend replacement of appliance

Gas pipe work

  • Gas pipe satisfactory

  • Tightness test satisfactory

  • LDF used on test points

Electrical

  • Earth bonding satisfactory

  • RCD fuse box fitted

Additional information

  • Additional information

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.