Intergas Gas Quality Check Form

• Operative Name

• Work order Number

• Reason for Procedure Compliance Check

  Normal Scheduled Audit

  Priority Audit

  After Complaint

  After Gas Escape

  Client Request

• Procedure Compliance check Type

  Work in Progress

  Post Complete
• Location
  Address

• Conducted on

  Date

• Prepared by

Electrical

• Preliminary electrical checks carried out correctly.

  Yes

  No

  N/A

• Demonstrated Safe Isolation

  Yes

  No

  N/A

• Does the appliance have the correctly rated fuse.

  Yes

  No

  N/A

• Satisfactory distance from electrical wire/cables and gas pipework.

  Yes

  No

  N/A

Gas meter, ECV, and gas installation

• Meter installation satisfactory.

  Yes

  No

  N/A

• Did engineer check Correct labels fitted.

  Yes

  No

  N/A

• Did engineer check Correct equipotential bonding and pisitioning (Gas meter).

  Yes

  No

  N/A

• Did engineer check if Satisfactory gas pipework installation and sleeving.

  Yes

  No

  N/A

Testing

• Satisfactory full tightness test.

  Pass

  Fail

  N/A

• Satisfactory local tightness test.

  Pass

  Fail

  N/A

• Did engineer check Satisfactory meter regulator working pressure.

  Yes

  No

  N/A

Operational Checks And Inspections

• CO/CO2 Min/Max<br>PPM<br>Ratio

  Yes

  No

  N/A

• Did engineer check Flue route, integrity and termination.

  Yes

  No

  N/A

• Did engineer check Working pressure P1

  Pass

  Fail

  N/A

• Did engineer check Operation of safety device.

  Yes

  No

  N/A

• Did engineer check Case seal (Room sealed appliances)

  Yes

  No

  N/A

• Did engineer check Burner Condition

  Yes

  No

  N/A

• Front plate seal checked/replaced

  Yes

  No

  N/A

• Checked/Cleaned heat exchanger

  Yes

  No

  N/A

• Did engineer check Gas rate.

  Yes

  No

  N/A

• Water flow rates and temperature checked and set

  Yes

  No

  N/A

• Scale Protection checked by engineer<br>

  Yes

  No

  N/A

• C/H System water quality checked

  Yes

  No

  N/A

• C/H System filter fitted checked by engineer

  Yes

  No

  N/A

• Did engineer check Compliant with manufacturer's instructions.

  Yes

  No

  N/A

• Correct operations of heating controls checked.

  Yes

  No

  N/A

Benchmark completed & Service paperwork checked?

• Did engineer check that benchmark book completed

  Yes

  No

  N/A

• Gas safety record completed for service correctly and issued to customer.

  Yes

  No

  N/A

• Was a warning notices correctly issued and applied.

  Pass

  Fail

  N/A

• Was a warning sticker applied to the appliance

  Pass

  Fail

  N/A

Health and Safety

• Safe working practices applied.

  Yes

  No

  N/A

• Engineer Has up to date copy of the Gas industry unsafe situations procedure.

  Yes

  No

  N/A

• Engineer qualified for work carried out.

  Yes

  No

  N/A

• Engineer wearing issued uniform.

  Yes

  No

  N/A

• Safety footwear being worn.

  Yes

  No

  N/A

• Required PPE being worn.

  Yes

  No

  N/A

• PPE in good condition.

  Yes

  No

  N/A

• First aid kit available and stocked.

  Yes

  No

  N/A

• Fire extinguisher available and in date.

  Yes

  No

  N/A

Customer satisfaction

• Engineer possess and uses gas safe ID card.

  Yes

  No

  N/A

• Did the engineer phone ahead of planned visit.

  Yes

  No

  N/A

• Clean, tidy and protected working area/s.

  Yes

  No

  N/A

• Customer satisfied with quality of work

  Yes

  No

  N/A

• Appointed times agreed and met.

  Yes

  No

  N/A

• Did the Engineer explain to the customer what was done/needs to be done.

  Yes

  No

  N/A

• Engineers appearance

  Yes

  No

  N/A

Safe completion

• Has the appliance/installation been left safe for use.

  Yes

  No

  N/A

General comments/observations- Actions to be taken.

• undefined

Inspection carried out by

• Add signature

  Sign

• Select date

  Date

Operative comments

• This is a true reflection of my work.

• I agree to abide by the actions mentioned above.

Operative

• Add signature

  Sign

• Select date

  Date