HtG Gas Safety Inspection

• Plumbers name

• Plumber's License No

• Client/customer name

• Customer contact number

• Inspection site address

• Suburb

• Post code

Gas Installation Details

• LP gas cylinders and associated components (e.g. regulators, pigtails etc.) installed correctly?

  Yes

  No

  N/A

• Gas installation leakage test

  Pass

  Fail

  N/A

Gas Appliance Details

Gas Appliance(s)

• Gas appliance type

Gas Installation

• Gas appliance isolation valve located and isolated

  Yes

  No

  N/A

• Is the Gas Appliance electrically safe?

  Yes

  No

  N/A

• Adequate ventilation?

  Yes

  No

  N/A

• Adequate clearances to combustible surfaces?

  Yes

  No

  N/A

• Completed inspection in accordance with AS 4575?

  Yes

  No

  N/A

Faults Identified

• Were any faults detected today?

  Yes

  No

  N/A

• Are remedial actions required?

  Yes

  No

  N/A

Declaration

• I, Andrew Fothergill being the person responsible for the inspection of the identified gas appliances and/or installations at the abovementioned property found the abovementioned gas appliance(s) to be:

  Select Compliant Non-Compliant Unsafe

  • Compliant
  • Non-Compliant
  • Unsafe

Next Gas Safety Inspection

• Date

  Date

undefined

• Add signature

  Sign