Title Page
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Audit completed by
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Audit reference
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Audit Type
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Job Type
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Client Name
- Aspire Housing
- Peaks & Plains
- Connexus
- Newark & Sherwood District Council
- Homes Plus Group
- East Midlands Homes
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Location
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Operative Name
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Operative Gas Safe Licence Number
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Labour Type
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Inspection Date
Work In Progress
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Customer liaison / interaction
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Operative worked in a safe manner
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Protection of customers property (e.g. Dust sheets used)
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I.D / Licence card shown
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Operative knows where to find RAMS / Technical bulletins etc
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Safe isolation carried out
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Preliminary electrical tests done
Appliances
- Appliance Details
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Photo of appliance
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Appliance Make & Model
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Appliance Location
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Type of inspection
Appliance Checks
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1) Type of Control System
- S Plan
- S Plan Plus
- Y Plan
- C Plan
- C Plan Plus
- W Plan
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2) Max Primary Flow Temperature (Degrees C)
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3) Inlet Water Pressure (bar)
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4) Primary Heat Source
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5) Capacity (Ltrs)
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6) Pressure Reducing Valve (PRV) Setting (bar)
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7) Is the service valve working?
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8) Expansion Type?
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9) Expansion Vessel Size (Ltrs)
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10) D1 Installed to MI / BS?
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11) D2 Installed to MI / BS?
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12) Material Suitable?
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13) Tundish?
System Checks
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13) Relief Valve Type
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14) Relieve Valve
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15) Thermostat & Energy cut out?
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16) Check operation of motorised valve
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17) Tee present?
Thermostat & Cylinder Checks
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18) Cylinder and pipework supported?
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19) Pipework lagged as required?
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20) Hot water temperature at nearest tap (degrees C)
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21) Is the appliance safe to use?
Documentation
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22) Correct documentation available
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23) Work record completed correctly
Audit Outcome
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Audit Outcome
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Who will be involved in closing the corrective actions
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What are the recommendations
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What actions have been implemented
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What is the target date to close the corrective action
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Additional Notes
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Operative signature
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Quality Assessor signature
