Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location
  • Vba Lic#
  • Gas line pressure test

Untitled Page

  • Details of work to be carried out

  • Make

  • Model

  • Gas type

  • Serial#

  • Certification body

  • Certification number

  • Has the appliance been cleaned?

  • Is there evidence of product certification?

  • Is the appliance subject to any safety recalls?

  • Has the appliance been altered since manufacture in a manner which may render it unsafe?

  • Is the appliance certified for use in the location where it is installed and is it suitable for the connected gas supply?

  • Is the appliance installed in accordance with the relevant edition of AS/NZS 5601?

  • Is the appliance appropriately secured?

  • Is the appliance gas tight?

  • Is the flue cowl, chimney plate, flue terminal and flue in good condition and clear of obstruction?

  • Where applicable, does the appliance have an accessible means of electrical isolation?

  • Is the appliance regulator accessible for servicing and adjustment?

  • Is the flue, or it’s surroundings, clear of signs of scorching and overheating?

  • Is the flue adequately supported and correctly installed, sealed at roof penetration?

  • Is there any evidence of worn or damaged components?

  • Was there any build up of dust or foreign matter in or on the appliance that may affect correct operation?

  • Are flame sensor rods, ignition electrodes and thermocouples free of carbon deposits?

  • Hose assembly connections in good condition?

  • Is the gas supply pressure to the appliance inlet adequate (1.13 or 2.75kpa LPG) when all gas appliances are in operation?

  • Is the nominal burner pressure correct?

  • Is the ignition and re-ignition reliable and complete?

  • Does the flame safe guard allow flame establishment within the period specified in the appliance manufacturer’s instructions?

  • Does the flame safe guard isolate the gas supply when there has been an interruption to the gas supply?

  • Does the appliance burner flame exhibit any flame abnormality?

  • For appliances with turndown settings, does the burner flame remain stable when operated from the high and low settings?

  • Any abnormal noise and/or Vibration durning the operation of the appliance?

  • Are burner flames stable when opening and closing doors associated with the appliance or the installation?

  • Do control knobs and door handles become to hot to touch while in operation?

  • Are integral guards for space heaters adequately secured to the appliance and are they in good condition?

  • For heated water, has the PTR valve been checked for correct operation?

  • Is there any evidence of cracked heat exchanger?

  • For open flued appliances, does the appliance operate so that there is no spillage of combustion products in accordance with Appendix F?

  • Was negative pressure identified at the appliance?

  • Combustion detection equipment used? Instrument details

  • Instrument calibration date?

  • Number of exhaust fans?

  • Combustion products spillage ( CO Concentration (ppm) and/or CO2 (%))?

  • Background check appliance off?

  • Background check after 5 mins of appliance operation on high ( appliances other than type 1 decorative log fires) note: Allow an extra 5 mins if no chimney liner

  • Background check after 10mins of appliance operation on high ( type 1 decorative log fire in chimney)

  • Final reading at the appliance on high

  • Observation and faults identified during service?

  • I declare that the information in the record is not false or misleading in any material detail

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