Title Page
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Audit Title
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Conducted on
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ENSURE CORRECT DATE, TIME AND COMPLETION DETAILS ARE RECORDED, AS THEY WILL IMPACT THE ENGINEER'S PAY IF RECORDED INCORRECTLY.
CUSTOMER DETAILS
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Title:
- Mr
- Ms
- Mrs
- Miss
- Dr
- Lady
- Lord
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Name: (Inc Initials)
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Job Address: (edit address manually if displayed incorrectly)
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Telephone Number:
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Work Order No:
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PEMS INDICATOR
- Yes
- No
RESOURCE INFORMATION
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NAME:
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PAYROLL NO:
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CONTACT NUMBER:
VISIT DETAILS
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TIME ISSUED:
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TIME ONRT:
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TIME ONST:
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TIME TEAM REQUIRED:
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TIME COMPLETED:
JOB COMPLETION CODES FOR EMERGENCY WORK ONLY
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JOC 1
- NOC 1 Not On Contract For Post Emergency Work
- LCW 2 Non Chargeable Licence Condition Work
- COD 3 Carbon Monoxide Detector
- ECR 4 Exchanged Credit Meter
- EPP 5 Exchanged PP Meter
- CIG 6 Exchanged Credit Meter, Inlet and Governor
- PIG 7 Exchanged PP Meter, Inlet and Governor
- CMI 8 Exchanged Credit Meter and Inlet
- CMG 9 Exchanged CreditM Meter and Governor
- PMI 10 Exchanged PP Meter and Inlet
- PMG 11 Exchanged PP Meter and Governor
- RIG 12 Replaced Inlet and Governor
- E16 13 Exchanged U16 Credit Meter
- C16 14 Exchanged U16 Meter, Regulator and Inlet
- R16 15 Exchanged U16 Regulator and Inlet
- RIN 16 Replaced Inlet
- REG 17 Replaced Governor
- USM 18 Upgraded Sub Standard Meter Installation
- URM 19 Upgrade Required of Meter Installation
- NSI 20 Non Standard Meter Installation
- TGS 21 TOG Safety Situation
- MNC 22 Meter Work Not Complete Engineer Called Away
- MNM 23 Meter Work Not Completed No Materials Available
- MNR 24 Meter Work Not Complete Re-Site Required
- OUT 25 OUT
- PRP 26 Interference Damage Emergency
- RCK 27 Recheck
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JOC 2
- DTE 4,5,6,7,8,9,10,11,12,13,14,15,16,17 DUE TO ESCAPE
- DTF 4,5,6,7,8,9,10,11,12,13,14,15,16,17 DUE TO FAULT
- DTD 4,5,6,7,8,9,10,11,12,13,14,15,16,17 DUE TO DAMAGE
- DTW 4,5,6,7,8,9,10,11,12,13,14,15,16,17 DUE TO PLANT FAILURE/WATER INGRESS
- SIS 18 SAFETY ISSUE
- MSC 1,20,21,22,23,24 MADE SAFE ONLY 'Customer advised to contact supplier'
- MFR 1 METER FAULTY REQUIRES REPLACING
- MLR 1 METER LEAKING REQUIRES REPLACING
- IGR 1 INLET/GOVERNOR REQUIRES REPLACING
- IRR 1 INLET REQUIRES REPLACING
- GRR 1 GOVERNOR REQUIRES REPLACING
- MIG 1 METER INLET/GOVERNOR REQUIRES REPLACING
- ACW 1 ADVERSARIAL CONSUMER WORK COMPLETED
- MFS 1 METER FITTED SUBSTANDARD/FURTHER WORK REQUIRED
- MDR 1 METER/INDEX DAMAGED/VANDALISED REQUIRES REPLACING
- MTR 1 METER TEST POINT SPLIT/BROKEN REQUIRES REPLACEMENT
- ADO 2,19 ADVICE ONLY
- MDA 19 METER DAMAGED
- SFU 2 SUSPECT FUMES
- LAD 2 LOCAL AUTHORITY DISC IN OUTLET
- GSR 2 GAS SAFETY REGULATIONS
- BFN 3 BATTERY - FAILURE NO CO EVIDENT
- BFS 3 BATTERY FAILURE - SUSPECT CO EVIDENT
- BFC 3 BATTERY FAILURE - CO EVIDENT
- BON 3 ACTIVE ALARM - NO CO EVIDENT
- BOS 3 ACTIVE ALARM - SUSPECT CO EVIDENT
- BOC 3 ACTIVE ALARM - CO EVIDENT
- END 25,26,27,28,29,30,31 END
- ECV 2 EXCHANGE EMERGENCY CONTROL VALVE
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JOC 3
- N/A-NOT APPLICABLE
- RIS Regulator Inspected Satisfactory
- RDS Regulator Donkin 225/2 Exchanged Found Satisfactory
- RDU Regulator Donkin 225/2 Exchanged Found Unsatisfactory
- RSS Regulator Sperryn G910 Exchanged Found Satisfactory
- RSU Regulator Sperryn G910 Exchanged Found Unsatisfactory
- RJS Regulator Jeavons J88 Exchanged Found Satisfactory
- RJU Regulator Jeavons J88 Exchanged Found Unsatisfactory
- RPS Regulator PRS3/SEMI Concealed Type Present
- RXS Regulator Exchanged Satisfactory
- RXU Regulator Exchanged Unsatisfactory
- RMP Regulator Medium Pressure Present
- RUS Regulator UGI FC1 Satisfactory
- RUU Regulator UGI FC1 Unsatisfactory
- RYS Regulator Parkinson Cowan Exchanged Found Satisfactory
- RYU Regulator Parkinson Cowan Exchanged Found Unsatisfactory
- RZS Regulator Model Z Satisfactory
- RZU Regulator Model Z Unsatisfactory
- NGP No Gas In Property
- NAP Not Applicable
- IGT Independent Gas Transporter
- LPG LPG Site
- RTF Target Regulator Found Not Exchanged
- END END
WORK REPORT
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PLEASE ENTER WORK REPORT (WORK COMPLETED ON SITE):
WORK COMPLETION REASON
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Please Select Response
- PERMANENT REPAIR
- MADE SAFE
- NO TRACE
- NO TRACE - RECHECK
- NO ACCESS
- TEAM REQUEST
- PROGRAMMED
MANDATORY DATA FORM - STATUS OF SUPPLY
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Status of Supply:
- LIVE & IN USE
- LIVE BUT CAPPED AT METER OUTLET
- NO SUPPLY TO PROPERTY
- LIVE CLAMPED
- TURNED OFF
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GAS OFF TIME: (only enter if applicable)
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Final Tightness Test Carried Out?
- Yes and Passed
- Yes and Failed
- Not Carried Out
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Outlet Pipe Repaired?
- Yes
- No
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Did You Work on Meter or Installation?
- Yes
- No
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Number of Storeys in Building:
- 1
- 2
- 3
- 4 or more
REPORT INDICATORS
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RIDDOR:
- Yes
- No
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ALLEGED THEFT OF GAS:
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Did You Check/Work on Appliance/Installation Pipework?
- Yes
- No
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CROSS BONDING:
- Yes
- No
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SUPPLIER SAFETY CHECK:
- Yes
- No
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REASON IF (NO) ENTERED ABOVE:
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SAFETY NOTICE ISSUED:
- Yes
- No
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INDEPENDENT GT (IGT):
- Yes
- No
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RIGHTS OF ENTRY - REG 5:
- Yes
- No
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EMERGENCY SERVICES ON SITE?
- Yes
- No
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INCIDENT NUMBER IF (YES) ENTERED ABOVE:
APPLIANCE/INSTALLATION INFORMATION
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APPLIANCE/INSTALLATION INFORMATION
Appliance/Installation
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APPLIANCE TYPE:
- 01 - Cooker
- 02 - Fire
- 03 - Fire/BBU
- 04 - Central Heating Boiler
- 05 - Wall Heater
- 06 - Water Heater
- 07 - Warm Air Heater
- 08 - Tumble Dryer
- 09 - Installation Pipework
- 10 - Other
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APPLIANCE LOCATION:
- 01 - Kitchen
- 02 - Lounge
- 03 - Dining Room
- 04 - Bedroom
- 05 - Hall
- 06 - Landing
- 07 - Bathroom
- 08 - Utility Room
- 09 - Other
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APPLIANCE STATE:
- ATR - At Risk
- CFS - Concern For Safety
- IMDGS - Immediately Dangerous
- NA - NA
- SATF - Satisfactory
- UNCOM - Uncommissioned Appliance
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DISCONNECTED:
- Yes
- No
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VISUAL CHECK AND RELIGHT ONLY:
- Yes
- No
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FLUE SATISFACTORY:
- Yes
- No
- N/A
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VENTILATION SATISFACTORY:
- Yes
- No
- N/A
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DANGEROUS APPLIANCE INSTALLATION LABEL ATTACHED:
- Yes
- No
APPLIANCE DELIVERY
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Reason For Leaving Appliance:
- OFGEM Priority
- National Grid Dx Priority
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Reason For Non Delivery:
- Not Eligible
- Not Offered
- Labour Dispute
- Force Majeure
- Severe Weather Conditions
- Customer Has Already Alternative Cooking & Heating
- Follow Up Visit Required
- Delayed At Customer Request
- Consumer Agreed Delay
- Gas Back On To Appliance <4hrs > 8hrs
- Scheduled 2b Interruption (e.g. Due to Debt)
- Consumer Agreed to Collect From Central Point (INCIDENT ONLY)
- Legislative Constraints
- Customer Declined Offer
- Gas Safety Regs Cut Off
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E15 Reference Number:
SITE REPORT
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SUSPECTED SOURCE OF ESCAPE:
- MAIN
- SERVICE
- ASSOCIATED PLANT
- POOR PRESSURE
- WATER INGRESS
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GAS IN PROPERTY:
- Yes
- No
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DAMAGE CAUSED BY THIRD PARTY:
- Yes
- No
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Enter Comments If (YES) Entered Above:
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HAS EXCAVATION BEEN LEFT VENTING:
- Yes
- No
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Current Visit's HIGHEST % LEL:
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NOT INVOLVING NATURAL GAS:
- Yes
- No
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IS GAS ESCAPE STOPPED:
- Yes
- No
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IF ENTERED (YES) ABOVE - PLEASE INDICATE GAS STOPPED DATE AND TIME:
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GAS AT ECV DATE AND TIME:
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HAS GAS BEEN INTERRUPTED:
- Yes
- No
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IF ENTERED (YES) ABOVE - PLEASE INDICATE GAS INTERRUPTION DATE AND TIME:
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INTERRUPTION CATEGORY:
- DOMESTIC
- NON-DOMESTIC
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INTERRUPTION REASON:
- Services Alter by Conx/Shipper
- Use on Planned/Project Work Only
- Mains Workthrough Connections
- Leaking/Water/Clear Service
- Mains Escape/Mains Related Escape
- Interrupted In Error
- Damaged Main/Service Supply Interrupted
- Major Network Failure (Call Manager)
- Network Failure
- No Interruption/Already Reported
- Service Alteration Shipper
- Planned Project Work
- Leakage
- Damaged
- Service Alteration
- Not Applicable
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PART of INCIDENT? (>250 properties):
- Yes
- No
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THIS SECTION ONLY TO BE COMPLETED IF ESCAPE IS POOR PRESSURE OR WATER INGRESS
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Vulnerable Customer:
- Yes
- No
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More Than 2 Properties Affected:
- Yes
- No
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Is Supply Isolated:
- Yes
- No
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STANDING PRESSURE (mBar):
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WORKING PRESSURE (mBar):
RISK SCORE FORM
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PRESSURE:
- IP (20 POINTS)
- MP (20 POINTS)
- LP (1 POINT)
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MATERIAL:
- METAL (5 POINTS)
- PE (1 POINT)
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GAS IN DUCTS:
- YES (15 POINTS)
- NO (0 POINTS)
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NUMBER OF PUBLIC BAR HOLES MADE:
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NUMBER OF PRIVATE BAR HOLES MADE:
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HIGHEST Reading and Distance (M) from PROPERTY (GIA/LEL):
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NEAREST Reading and Distance (M) from PROPERTY (GIA/LEL):
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GROUND CONDITION:
- OPEN (0 POINTS)
- CLOSED (10 POINTS)
- FROZEN (10 POINTS)
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SIZE OF MAIN:
- 14" AND ABOVE (PE - 400MM) (10 POINTS)
- 8" TO 13" (PE 200MM-335MM) (6 POINTS)
- 4" TO 7" (100MM-180MM) (4 POINTS)
- 3" (90MM) OR LESS (2 POINTS)
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PROXIMITY OF MAIN:
- LESS THAN 1.75M (10 POINTS)
- 1.75M TO 5.0M (6 POINTS)
- 5.1M TO 30M (3 POINTS)
- GREATER THAN 30M (1 POINT)
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RISK SCORE:
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COMMENTS:
IGT INTERNAL CHARGEABLE WORK
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IGT REFERENCE NUMBER:
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NETWORK:
- NG Dx
- IGT
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Contact Details:
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Site Contact Name:
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Job Address: (edit address manually if displayed incorrectly, include any Flat Numbers)
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Work Details:
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Are plans on site:
- Yes
- No
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Work Type:
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Manager On Site:
- Yes
- No
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Scenario:
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List of fittings used:
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FCO TO SIGN DOCUMENT AS COMPLETE:
FOR MI PURPOSES WHEN MANUAL (DETAILS OF THE PERSON CARRYING OUT THE WORK RECOVERY) NOT TO BE COMPLETED BY THE FCO
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NAME:
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DATE:
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TIME:
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JOB RECEIPT TIME:
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JOB CLASSIFICATION (Please Circle): P1 P2
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JOB IN STANDARD (Please Circle): YES NO
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Masternaut / Voice / System (Please Circle): On Site Time:
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Network (Please Circle): NW WM EM EA NL
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PLEASE ENTER TYPE OF JOB: e.g. Internal/External...