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

CUSTOMER DETAILS

  • Title:

  • Name: (Inc Initials)

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

  • Work Order No:

  • PEMS INDICATOR

RESOURCE INFORMATION

  • NAME:

  • PAYROLL NO:

  • CONTACT NUMBER:

VISIT DETAILS

  • TIME ISSUED:

  • TIME ONRT:

  • TIME ONST:

  • TIME TEAM REQUIRED:

  • TIME COMPLETED:

JOB COMPLETION CODES FOR EMERGENCY WORK ONLY

  • JOC 1

  • JOC 2

  • JOC 3

WORK REPORT

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

WORK COMPLETION REASON

  • Please Select Response

MANDATORY DATA FORM - STATUS OF SUPPLY

  • Status of Supply:

  • GAS OFF TIME: (only enter if applicable)

  • Final Tightness Test Carried Out?

  • Outlet Pipe Repaired?

  • Did You Work on Meter or Installation?

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

  • Number of Storeys in Building:

REPORT INDICATORS

  • RIDDOR:

  • ALLEGED THEFT OF GAS:

  • CROSS BONDING:

  • SUPPLIER SAFETY CHECK:

  • REASON IF (NO) ENTERED ABOVE:

  • SAFETY NOTICE ISSUED:

  • INDEPENDENT GT (IGT):

  • RIGHTS OF ENTRY - REG 5:

  • EMERGENCY SERVICES ON SITE?

  • INCIDENT NUMBER IF (YES) ENTERED ABOVE:

APPLIANCE/INSTALLATION INFORMATION

  • APPLIANCE/INSTALLATION INFORMATION

  • Appliance/Installation
  • APPLIANCE TYPE:

  • APPLIANCE LOCATION:

  • APPLIANCE STATE:

  • DISCONNECTED:

  • VISUAL CHECK AND RELIGHT ONLY:

  • FLUE SATISFACTORY:

  • VENTILATION SATISFACTORY:

  • DANGEROUS APPLIANCE INSTALLATION LABEL ATTACHED:

APPLIANCE DELIVERY

  • Reason For Leaving Appliance:

  • Reason For Non Delivery:

  • E15 Reference Number:

SITE REPORT

  • SUSPECTED SOURCE OF ESCAPE:

  • GAS IN PROPERTY:

  • DAMAGE CAUSED BY THIRD PARTY:

  • Enter Comments If (YES) Entered Above:

  • HAS EXCAVATION BEEN LEFT VENTING:

  • Current Visit's HIGHEST % LEL:

  • NOT INVOLVING NATURAL GAS:

  • IS GAS ESCAPE STOPPED:

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

  • GAS AT ECV DATE AND TIME:

  • HAS GAS BEEN INTERRUPTED:

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

  • INTERRUPTION CATEGORY:

  • INTERRUPTION REASON:

  • PART of INCIDENT? (>250 properties):

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

  • Vulnerable Customer:

  • More Than 2 Properties Affected:

  • Is Supply Isolated:

  • STANDING PRESSURE (mBar):

  • WORKING PRESSURE (mBar):

RISK SCORE FORM

  • PRESSURE:

  • MATERIAL:

  • GAS IN DUCTS:

  • 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:

  • SIZE OF MAIN:

  • PROXIMITY OF MAIN:

  • RISK SCORE:

  • COMMENTS:

IGT INTERNAL CHARGEABLE WORK

  • IGT REFERENCE NUMBER:

  • NETWORK:

  • Contact Details:

  • Site Contact Name:

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

  • Are plans on site:

  • Work Type:

  • Manager On Site:

  • Scenario:

  • List of fittings used:

  • 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

  • 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...

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