• Date & time

  • Address details

  • Type of appliance ?

  • Make and model of appliance

  • Flue type

  • Visual condition of appliance/flue termination acceptable

  • Satisfactory flue flow test

  • Satisfactory spillage test

  • Gas pipe work satisfactory

  • Tightness test satisfactory

  • Earth bonding satisfactory

  • Appliance safe to use

  • Condition of appliance 0 = poor 10 = excellent

  • Recommend replacement of appliance

  • LDF used on test points

  • RCD fuse box fitted

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