Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
Gas Appliance Breakdown
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Tenant/Homeowner complaint
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Make & Model of Appliance
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What issue was discovered?
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Does the appliance need parts?
- Yes
- No
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Which part/s are required to rectify issue?
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Quote for parts / replacement
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Is the appliance fixed and operational?
- Yes - Safe to use
- No - Parts Required
- No - At Risk, has been isolated
