Rough in Gas Pipework Pressure Test

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Works carried out under gas permit number

• PERMIT NUMBER:

Roughin works complete

• All Roughing works completed, including risers and Isolation. <br>

  Yes

  No

  N/A

• Reason for works not being completed

• Type of test

  Air pressure test

  " water column

Installation type

• Heating

  Hot water

  Cold water Mains

  Snow melt

• Is installation clearly marked on drawings, "As Built"

• Yes

• No

• Sketch of localised pipe runs or location (if required)

  Drawing

• Add media

  Media

• Pressure test held for a period of no less than 30 min at at min pressure of 5psi (35 Kpa) as per code. <br>

  Yes

  No

  N/A

• Check all joints and fittings and retest

• Gauge pressure

  Media

• Start time of test

  Date

• End time of test

  Date

• This will certify that I have tested the piping installed under the above permit with air at a
  minimum pressure of 5 p.s.i./ 35 KPa gauge for a minimum of 30 min with no loss of pressure
  and that, to my knowledge, all piping, appliances and vents are installed in accordance with the
  latest edition of the CAN/CSA Gas Code and have been left in a safe condition.
  
  

• Installer / Lead Hand

  Sign

Customer sign off

• Add signature

  Sign