JOB REPORT FORM (EMERGENCY) v1.1

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• ENSURE CORRECT DATE, TIME AND COMPLETION DETAILS ARE RECORDED, AS THEY WILL IMPACT THE ENGINEER'S PAY IF RECORDED INCORRECTLY.

CUSTOMER DETAILS

• Title:

  Select Mr Ms Mrs Miss Dr Lady Lord

  • Mr
  • Ms
  • Mrs
  • Miss
  • Dr
  • Lady
  • Lord

• Name: (Inc Initials)

• Job Address: (edit address manually if displayed incorrectly)
  Address

• Telephone Number:

• Work Order No:

• PEMS INDICATOR

  Select Yes No

  • Yes
  • No

RESOURCE INFORMATION

• NAME:

• PAYROLL NO:

• CONTACT NUMBER:

VISIT DETAILS

• TIME ISSUED:

  Date

• TIME ONRT:

  Date

• TIME ONST:

  Date

• TIME TEAM REQUIRED:

  Date

• TIME COMPLETED:

  Date

JOB COMPLETION CODES FOR EMERGENCY WORK ONLY

• JOC 1

  Select 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

  • 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

• JOC 2

  Select 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

  • 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

• JOC 3

  Select 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

  • 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

• PLEASE ENTER WORK REPORT (WORK COMPLETED ON SITE):

WORK COMPLETION REASON

• Please Select Response

  Select PERMANENT REPAIR MADE SAFE NO TRACE NO TRACE - RECHECK NO ACCESS TEAM REQUEST PROGRAMMED

  • PERMANENT REPAIR
  • MADE SAFE
  • NO TRACE
  • NO TRACE - RECHECK
  • NO ACCESS
  • TEAM REQUEST
  • PROGRAMMED

MANDATORY DATA FORM - STATUS OF SUPPLY

• Status of Supply:

  Select LIVE & IN USE LIVE BUT CAPPED AT METER OUTLET NO SUPPLY TO PROPERTY LIVE CLAMPED TURNED OFF

  • LIVE & IN USE
  • LIVE BUT CAPPED AT METER OUTLET
  • NO SUPPLY TO PROPERTY
  • LIVE CLAMPED
  • TURNED OFF

• GAS OFF TIME: (only enter if applicable)

  Date

• Final Tightness Test Carried Out?

  Select 1-Yes and Passed 2-Yes and Failed 3-Not Carried Out

  • 1-Yes and Passed
  • 2-Yes and Failed
  • 3-Not Carried Out

• Outlet Pipe Repaired?

  Select Yes No

  • Yes
  • No

• Did You Work on Meter or Installation?

  Select Yes No

  • Yes
  • No

• Did You Check/Work on Appliance/Installation Pipework?

  Select Yes No

  • Yes
  • No

• Number of Storeys in Building:

  Select 1 2 3 4 or more

  • 1
  • 2
  • 3
  • 4 or more

REPORT INDICATORS

• RIDDOR:

  Select Yes No

  • Yes
  • No

• ALLEGED THEFT OF GAS:

  Yes

  No

• CROSS BONDING:

  Select Yes No

  • Yes
  • No

• SUPPLIER SAFETY CHECK:

  Select Yes No

  • Yes
  • No

• REASON IF (NO) ENTERED ABOVE:

• SAFETY NOTICE ISSUED:

  Select Yes No

  • Yes
  • No

• INDEPENDENT GT (IGT):

  Select Yes No

  • Yes
  • No

• RIGHTS OF ENTRY - REG 5:

  Select Yes No

  • Yes
  • No

• EMERGENCY SERVICES ON SITE?

  Select Yes No

  • Yes
  • No

• INCIDENT NUMBER IF (YES) ENTERED ABOVE:

APPLIANCE/INSTALLATION INFORMATION

• APPLIANCE/INSTALLATION INFORMATION

Appliance/Installation

• APPLIANCE TYPE:

  Select 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

  • 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

• APPLIANCE LOCATION:

  Select 01 - Kitchen 02 - Lounge 03 - Dining Room 04 - Bedroom 05 - Hall 06 - Landing 07 - Bathroom 08 - Utility Room 09 - Other

  • 01 - Kitchen
  • 02 - Lounge
  • 03 - Dining Room
  • 04 - Bedroom
  • 05 - Hall
  • 06 - Landing
  • 07 - Bathroom
  • 08 - Utility Room
  • 09 - Other

• APPLIANCE STATE:

  Select ATR - At Risk CFS - Concern For Safety IMDGS - Immediately Dangerous NA - NA SATF - Satisfactory UNCOM - Uncommissioned Appliance

  • ATR - At Risk
  • CFS - Concern For Safety
  • IMDGS - Immediately Dangerous
  • NA - NA
  • SATF - Satisfactory
  • UNCOM - Uncommissioned Appliance

• DISCONNECTED:

  Select Yes No

  • Yes
  • No

• VISUAL CHECK AND RELIGHT ONLY:

  Select Yes No

  • Yes
  • No

• FLUE SATISFACTORY:

  Select Yes No N/A

  • Yes
  • No
  • N/A

• VENTILATION SATISFACTORY:

  Select Yes No N/A

  • Yes
  • No
  • N/A

• DANGEROUS APPLIANCE INSTALLATION LABEL ATTACHED:

  Select Yes No

  • Yes
  • No

APPLIANCE DELIVERY

• Reason For Leaving Appliance:

  Select OFGEM Priority National Grid Dx Priority

  • OFGEM Priority
  • National Grid Dx Priority

• Reason For Non Delivery:

  Select 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

  • 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

• E15 Reference Number:

SITE REPORT

• SUSPECTED SOURCE OF ESCAPE:

  Select MAIN SERVICE ASSOCIATED PLANT POOR PRESSURE WATER INGRESS

  • MAIN
  • SERVICE
  • ASSOCIATED PLANT
  • POOR PRESSURE
  • WATER INGRESS

• GAS IN PROPERTY:

  Select Yes No

  • Yes
  • No

• DAMAGE CAUSED BY THIRD PARTY:

  Select Yes No

  • Yes
  • No

• Enter Comments If (YES) Entered Above:

• HAS EXCAVATION BEEN LEFT VENTING:

  Select Yes No

  • Yes
  • No

• Current Visit's HIGHEST % LEL:

• NOT INVOLVING NATURAL GAS:

  Select Yes No

  • Yes
  • No

• IS GAS ESCAPE STOPPED:

  Select Yes No

  • Yes
  • No

• IF ENTERED (YES) ABOVE - PLEASE INDICATE GAS STOPPED DATE AND TIME:

  Date

• GAS AT ECV DATE AND TIME:

  Date

• HAS GAS BEEN INTERRUPTED:

  Select Yes No

  • Yes
  • No

• IF ENTERED (YES) ABOVE - PLEASE INDICATE GAS INTERRUPTION DATE AND TIME:

  Date

• INTERRUPTION CATEGORY:

  Select DOMESTIC NON-DOMESTIC

  • DOMESTIC
  • NON-DOMESTIC

• INTERRUPTION REASON:

  Select 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

  • 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

• PART of INCIDENT? (>250 properties):

  Select Yes No

  • Yes
  • No

• THIS SECTION ONLY TO BE COMPLETED IF ESCAPE IS POOR PRESSURE OR WATER INGRESS

• Vulnerable Customer:

  Select Yes No

  • Yes
  • No

• More Than 2 Properties Affected:

  Select Yes No

  • Yes
  • No

• Is Supply Isolated:

  Select Yes No

  • Yes
  • No

• STANDING PRESSURE (mBar):

• WORKING PRESSURE (mBar):

RISK SCORE FORM

• PRESSURE:

  Select IP (20 POINTS) MP (20 POINTS) LP (1 POINT)

  • IP (20 POINTS)
  • MP (20 POINTS)
  • LP (1 POINT)

• MATERIAL:

  Select METAL (5 POINTS) PE (1 POINT)

  • METAL (5 POINTS)
  • PE (1 POINT)

• GAS IN DUCTS:

  Select YES (15 POINTS) NO (0 POINTS)

  • YES (15 POINTS)
  • NO (0 POINTS)

• NUMBER OF PUBLIC BAR HOLES MADE:

• NUMBER OF PRIVATE BAR HOLES MADE:

• HIGHEST Reading and Distance (M) from PROPERTY (GIA/LEL):

• NEAREST Reading and Distance (M) from PROPERTY (GIA/LEL):

• GROUND CONDITION:

  Select OPEN (0 POINTS) CLOSED (10 POINTS) FROZEN (10 POINTS)

  • OPEN (0 POINTS)
  • CLOSED (10 POINTS)
  • FROZEN (10 POINTS)

• SIZE OF MAIN:

  Select 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)

  • 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)

• PROXIMITY OF MAIN:

  Select LESS THAN 1.75M (10 POINTS) 1.75M TO 5.0M (6 POINTS) 5.1M TO 30M (3 POINTS) GREATER THAN 30M (1 POINT)

  • LESS THAN 1.75M (10 POINTS)
  • 1.75M TO 5.0M (6 POINTS)
  • 5.1M TO 30M (3 POINTS)
  • GREATER THAN 30M (1 POINT)

• RISK SCORE:

• COMMENTS:

IGT INTERNAL CHARGEABLE WORK

• IGT REFERENCE NUMBER:

• NETWORK:

  Select NG Dx IGT

  • NG Dx
  • IGT

• Contact Details:

• Site Contact Name:

• Job Address: (edit address manually if displayed incorrectly, include any Flat Numbers)
  Address

• Work Details:

• Are plans on site:

  Select Yes No

  • Yes
  • No

• Work Type:

• Manager On Site:

  Select Yes No

  • Yes
  • No

• Scenario:

• List of fittings used:

• FCO TO SIGN DOCUMENT AS COMPLETE:

  Sign

FOR MI PURPOSES WHEN MANUAL (DETAILS OF THE PERSON CARRYING OUT THE WORK RECOVERY) NOT TO BE COMPLETED BY THE FCO

• NAME:

• DATE:

• TIME:

• JOB RECEIPT TIME:

• JOB CLASSIFICATION (Please Circle): P1 P2

• JOB IN STANDARD (Please Circle): YES NO

• Masternaut / Voice / System (Please Circle): On Site Time:

• Network (Please Circle): NW WM EM EA NL

• PLEASE ENTER TYPE OF JOB: e.g. Internal/External...