Gas service schedule

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Information

• Date

  Date

• Name and address of customer

Appliance

• Type of appliance

  boiler

  fire

  hob

  cooker

• Make & model

• Flue type

  room sealed

  open flue

  flueless

• 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