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
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Vba Lic#
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Gas line pressure test
Untitled Page
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Details of work to be carried out
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Make
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Model
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Gas type
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Serial#
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Certification body
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Certification number
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Has the appliance been cleaned?
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Is there evidence of product certification?
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Is the appliance subject to any safety recalls?
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Has the appliance been altered since manufacture in a manner which may render it unsafe?
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Is the appliance certified for use in the location where it is installed and is it suitable for the connected gas supply?
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Is the appliance installed in accordance with the relevant edition of AS/NZS 5601?
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Is the appliance appropriately secured?
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Is the appliance gas tight?
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Is the flue cowl, chimney plate, flue terminal and flue in good condition and clear of obstruction?
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Where applicable, does the appliance have an accessible means of electrical isolation?
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Is the appliance regulator accessible for servicing and adjustment?
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Is the flue, or it’s surroundings, clear of signs of scorching and overheating?
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Is the flue adequately supported and correctly installed, sealed at roof penetration?
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Is there any evidence of worn or damaged components?
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Was there any build up of dust or foreign matter in or on the appliance that may affect correct operation?
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Are flame sensor rods, ignition electrodes and thermocouples free of carbon deposits?
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Hose assembly connections in good condition?
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Is the gas supply pressure to the appliance inlet adequate (1.13 or 2.75kpa LPG) when all gas appliances are in operation?
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Is the nominal burner pressure correct?
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Is the ignition and re-ignition reliable and complete?
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Does the flame safe guard allow flame establishment within the period specified in the appliance manufacturer’s instructions?
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Does the flame safe guard isolate the gas supply when there has been an interruption to the gas supply?
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Does the appliance burner flame exhibit any flame abnormality?
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For appliances with turndown settings, does the burner flame remain stable when operated from the high and low settings?
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Any abnormal noise and/or Vibration durning the operation of the appliance?
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Are burner flames stable when opening and closing doors associated with the appliance or the installation?
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Do control knobs and door handles become to hot to touch while in operation?
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Are integral guards for space heaters adequately secured to the appliance and are they in good condition?
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For heated water, has the PTR valve been checked for correct operation?
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Is there any evidence of cracked heat exchanger?
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For open flued appliances, does the appliance operate so that there is no spillage of combustion products in accordance with Appendix F?
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Was negative pressure identified at the appliance?
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Combustion detection equipment used? Instrument details
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Instrument calibration date?
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Number of exhaust fans?
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Combustion products spillage ( CO Concentration (ppm) and/or CO2 (%))?
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Background check appliance off?
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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
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Background check after 10mins of appliance operation on high ( type 1 decorative log fire in chimney)
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Final reading at the appliance on high
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Observation and faults identified during service?
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I declare that the information in the record is not false or misleading in any material detail