Title Page
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Site location:
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PM Numbers covered in this report
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Client
- Westmorland and Furness Council, South Lakeland House, Lowther St, Kendal, LA9 4DQ
- Cumberland Council, Cumbria House, 107-117 Botchergate, Carlisle, CA1 1RD
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Conducted on:
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Report prepared by:
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Gas Safe Licence No.
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Are you wearing your personal CO alarm and have confirmed operation?
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DO NOT ENTER THE PLANT ROOM WITHOUT A CO ALARM
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Please take a photo of BMS panel switch positions before commencing any work
CDM
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Have you been shown the site asbestos register?
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Is there a toilet available on site?
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Is there anything site has made you aware of?
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Please state
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Risk of falls from height
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Risk of collapse of excavations
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Risk of collapse of structures
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Risk of exposure to building dust
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Risk of exposure to asbestos
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Supervision required
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Electrical works
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Are you following safe electrical procedures?
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Risk to others?
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Other dangers?
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Please state
Gas Installation
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PM Number
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Meter/ Emergency Control Valve accessible?
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Fuel type
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Gas Tightness Test satisfactory
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Pipework installed, identified correctly and in satisfactory condition?
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What is the issue
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Please take a photo of the pipework/fault
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Is the installation safe to use?
Gas Solenoid Valve
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PM Number
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Photo of solenoid
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Gas solenoid visual and functional check
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What is the issue?
Gas Appliance
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PM Number
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Location
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Engineer
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Type of work done
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Fuel type
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Description ( i.e. Boiler 1)
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Owner
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Type of appliance
- Boiler
- Warm Air Heater
- Water Heater
- Radiant Tube Heater
- Gas Fire
- Cooker
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Make, model and kW rating
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Flue type
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Low level ventilation requirement- cm2 ( gross if more than one unit )
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Low level ventilation measurement- cm2
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High level ventilation requirement- cm2 ( gross if more than one unit )
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High level ventilation measurement- cm2
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Ventilation Satisfactory
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Safety controls working?
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Flue visual check
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Flue termination satisfactory?
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Flue flow satisfactory?
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Spillage test satisfactory?
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Appliance safe to use?
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Reason appliance is not safe to use
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Warning notice issued
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Copy of combustion analysis
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Details of remedial works required
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Photo of appliance
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Data plate photo
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Integral pump?
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Engineers Signature
Flues
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PM Number
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Flue Description
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Photo of flue
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Visual check
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Functional check (flow and spillage tests)
Pump
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PM Number
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Description ( i.e. VT pump 2 )
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Make and model
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Photo of pump
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Data plate photo
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Visual check
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What is the issue?
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Functional check
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What is the issue?
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Motor current reading (amps)
Cylinders/Water Heater
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PM Number
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Type of unit ( i.e DHW cylinder/water heater or solar preheat )
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Make and model
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Photo of unit
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Data plate photo
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Capacity ( litres )
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Cylinder/Water Heater photos
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Cylinder/Water Heater data plate photo
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Description ( i.e. Cylinder 1 or Kitchen cylinder/water heater)
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Indirect, Direct or Point of Use?
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Safety valve(s) operation checked? ( if applicable )
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Did the valve(s) re-seat properly or is it/are they passing?
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Please take a photo of the valve that is passing
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Visual check of unit and ancillary equipment
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What is the issue?
Expansion Vessel
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PM Number
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Description ( i.e. Heating vessel or DHW vessel 1 )
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Expansion vessel photos
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Capacity ( litres )
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Visual check
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What is the issue?
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Pre-charge pressure checked?
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Pre-charge pressure (bar)
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Reason for not checking
- No lockable valve and drain off fitted
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Has vessel been re-charged with Nitrogen?
Pressurisation Unit
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PM Number
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Photo of unit
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Pressurisation Unit functional check
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What is the issue?
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Quick fill loop functional check
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What is the issue?
Boosted Cold Water Pump
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PM Number
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Photo of pump
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Data plate photo
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Boosted cold water pump visual/fuctional check
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What is the issue?
Condensate Pump
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PM Number
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Photo of condensate pump
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Condensate pump visual/functional check
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What is the issue?
Chemical Dosing Check
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PM Number
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PH reading of system water
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Is the PH value between 8 and 9.5?
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System water sample taken
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Why not?
Magnetic Filter Check
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PM Number
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Photo of filter
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Filter dismantled and cleaned?
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New filter elements fitted if applicable?
DHW Solar Assistance
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PM Number
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Does the DHW system have solar/thermal assistance?
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Is a separate Solar/Thermal Report complete?
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Why not?
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Photos of ancillary equipment
Air Source Heat Pump
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PM Number
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Photo of unit
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Visual check of unit
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What is the issue?
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Functional check of unit
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What is the issue?
UFH Manifold
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PM Number
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Photo of manifold
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Functional check of manifold
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What is the issue
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Visual check of manifold
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What is the issue?
Completion
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Have all BMS panel switches been put back to auto?
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Is a controls engineer required?
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Please take a photo to confirm BMS panel switch positions on completion
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Site responsible person to confirm completion
