Information

  • Document No.

  • Job Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • 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

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.