SPC Gas Quality Control Form

• Document No.

SPC GAS QUALITY CONTROL FORM

SITE DETAILS

• Name

• Add location
  Address

• Appliance 1

  Clients

  Tenants own

• Make / Model

• Location

• Flue Type

  OF

  RS

  FL

CHECKLIST

• 01. Gas meter - Location / Standard Notices?

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 02. Gas tightness test - Satisfactory?

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 03. Working pressure at Gas Meter and appliances confirmed?

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 04. Emergency / Meter control operable?

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 05. Labels - App / Gas Meter?

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 06. Pipe work - Integrity and routes?

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 07. Electrical cross bonding - evident?

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 08. Adequate ventilation / air supply?

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 09. Electrical Installation / Isolation?

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 10. Four preliminary electrical test?

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 11. Working pressure at appliance?

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 12. Dismantle and clean appliance?

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 13. Flue route?

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 13a. Termination?

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 13b. Integrity?

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 14. Flue flow?

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 15. Appliance operation safety devices - correct?

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 16. Gas rate?

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 16a. Burner pressure?

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 17. Spillage test?

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 18. Catchment space - Inspect / Size?

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 19. C/H System operation - Correct?

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 20. Appliance installation complies with GS (I & U) R & Man. Instructions?

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 21. Cooker - Stability Device Fitted?.

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 21a. Clearances?

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Measurements

• 22. All documentation and paperwork - Legible & Accurate - Complete?

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 23. Industry unsafe situation applied?

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 23a. Warning notice raised? (ID, AR, NCS)

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 24. Compliance with HASAWA Req?

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 25. Customer satisfaction card left / signature?

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 26. Equipment - Smoke matches, labels warning etc.

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• 27. Service label fitted?

  Satisfactory

  Unsatisfactory

  N/A

  Not inspected

• Comments

• Add media

  Media

SUMMARY

• Summary

  Green - Pass

  Orange - Improve

  Red - Fail

• Type of works

  Service

  Repair

  Installation

• Type of audit

  Observed

  Visual Post Inspection

  Strip Post

• Select date

  Date

• Engineer

  Sign

Positive Reporting (Observed Audits Only)

• In the opinion of the Auditor, has the Gas Engineer applied competence in the key gas safety areas as witnessed relevant to the scope of the work involved?

  Yes

  No

• Has a warning notice been raised?

  No

  Yes

• Has a RIDDOR been raised?

  No

  Yes

• Has a referral been raised?

  No

  Yes

• Details of further work required

• Auditor

  Sign

FM-04-33