Audit

Account Name

Postal Address

Name of Client

Site Address

Or GPS locate the site address

Customer Description

Contact

Description of Job

Date Received

Site assessment with construction plans & task analysis

Mark out gas appliance location & flue pathways

Discuss technical detail and compliance with Owner/Builder

Install gas pipework & pressure test to

KPa

Install gas appliance as per specific instructions

Leak test gas pipework to

KPa

Commission & certify to AS/NZS 5601:2010

Date Started
Date Completed

Order Number

Quote/Estimate

Tax Invoice Number

Home

Work

Mobile

Mobile 2

Fax

Email

Gas Appliance Markings

Make

Model

Serial Number

Isolating Valve

Clearances

Flue Type

Flue Position

Appliance Pressure

Appliance Pressure High

Appliance Pressure Low

Input Rating

Commissioned

Ventilation

Combustion

Seismic Restraint

Date of Install

Gas Certification Number

Category

Type

Gas Supplier

Labelled

Test Pressure

Test Time

Nil Leak Tolerance

Regulators

Auto

Manual

LP-HP

First Stage

Second Stage

Appliance Reg

Sign Initials

Customer Declaration

I authorise this contractor to carry out the work as detailed on this form. I understand that no significant additional work will be undertaken without my authorisation and I accept the terms and conditions. I will settle payment by:

Card Number

Expiry Date

Customers Signature

Materials

Quantity

Supplier Code

Description

Unit

Amount

Materials

Labour

Travel

Sub Total

GST

INVOICE TOTAL

Sign Initials

Labour & Travel

Date

Select date
Select date
Select date
Select date
Select date
Select date
Select date
Select date
Select date
Select date

Time

Select date
Select date
Select date
Select date
Select date
Select date
Select date
Select date
Select date
Select date

Initials

Add signature
Add signature
Add signature
Add signature
Add signature
Add signature
Add signature
Add signature
Add signature
Add signature
Add signature

Travel

Description

Comments

Sign Initials

Ventilation Requirements

For further information see ASNZS 5601:2010, Ventilation requirements, parts 1 & 2
In brief:
- 1.6.4 Ventilation shall ensure proper operation of the gas appliance and flueing system and maintain safe ambient conditions
- 2.2.6 Where a gas appliance is installed in a room, that room shall be ventilated
- Where the total input of open flued appliance exceeds 3MJ/hr for each cubic metre of room volume, the area shall be ventilated
- Where the total input of open flued appliance does not exceed 3MJ/hr per cubic metre of room volume, the required air may be provided by adventitious openings, ie gaps around doors and windows
- to establish whether the required air is to be provided by adventitious openings or additional openings. Calculate the total input of the gas appliance or appliance in the room in MJ/hr and divide by the room volume in cubic metres

Total gas input MJ/HR

Divided by

Room Volume m3 L x W x H

X

X

= m3

= MJ per cubic metre

2.6.6.1 Natural ventilation. Two permanent openings shall be provided each with a minimum free area as calculated using:
A = FxT formula
A = Minimum free area mm square
F = Factor given in table 13
T = Total gas consumption of all gas appliances

Adventitious Ventilation

Additional Ventilation Required

Checked

Initials
Drawings

Gascraft Engineering Ltd
PO Box 3176, Christchurch
Requirements for Pipesizing
- Calculate the total Gas consumption required in mj/hr
- Calculate the developed length of pipework in metres & label the start point and branch connections points alphabetically
- Indicate type of Gas utlised
- Select pipework material & determine the premissable drop ie: LP gas - 0.25
- Outline a schematic drawing of proposed pipework
- Use AS/NZS 5601:2010 Pipesizing tables

Pipe Section

Length M

Gas Flow MJ

Pipe Size MM

Completion of Work and Job Card

Signature of Technician
Date

Commissioning and Final Testing Checks (normal operating conditions)

Troubleshooting and Fault Finding

Have you remedied the ...

What is the Root Cause of this failure or breakdown?

Completion of Work & Job Card

Signature of Technician
Date Signed
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.