Title Page

  • Audit Type

  • Job Number

  • Address
  • Conducted on Engineer

  • Auditor Name

  • date

  • Repair/ASV/CP12

Boiler Details

  • Boiler Make

  • Boiler Model

  • Boiler GC Number

Health & Safety

  • Site Risk Assessment Carried Out

  • Appropriate PPE Worn for task

  • RCD Used (If Applicable)

  • Safe Working Practices Observed

  • Tools Maintained and Stored Correctly ( Take pictures including FGA Calibration picture)

  • PPE in good condition and correct stock

Electrical Testing

  • Does the engineer have correct equipment compliant with TB118a

  • Fuse Rating Checked

  • Ask underpinning knowledge question and record question number and result

  • Safe Isolation Procedure Carried Out

  • Ask underpinning knowledge question and record question number and result

  • Preliminary Electrical Tests Carried Out

Appliance Checks

  • Flue Construction, Route & Termination

  • Ask underpinning knowledge question and record question number and result

  • Flue Flow Test

  • Ask underpinning knowledge question and record question number and result

  • Spillage Test

  • Ask underpinning knowledge question and record question number and result

  • Ventilation Examined Fully

  • Ask underpinning knowledge question and record question number and result

  • Operating Pressure

  • Ask underpinning knowledge question and record question number and result

  • Heat Input

  • Ask underpinning knowledge question and record question number and result

  • Inlet Working Pressure

  • Ask underpinning knowledge question and record question number and result

  • Flue Gas Analysis

  • Ask underpinning knowledge question and record question number and result

  • F.S.D. Test

  • Ask underpinning knowledge question and record question number and result

  • Case Seals Inspected & Tested

  • Ask underpinning knowledge question and record question number and result

  • Condensate Pipe

  • Pressure Relief Pipework

  • Full Tightness Test

  • Ask underpinning knowledge question and record question number and result

  • All Disturbed Joints Tested

  • System Walked & Bled

  • Controls Tested

  • Unsafe Situation(s) Identified

  • Ask underpinning knowledge question and record question number and result

Job Completion

  • Controls Reset

  • Hand Held Device Fully Updated

  • Customer Job Sheet Completed

  • Safety Advice/Warning Notice Issued

  • Warning Label Attached

  • Appliance Turned Off/Capped Off

Customer Satisfaction

  • Vehicle Parked Appropriately

  • Customer Introduction

  • Gas Safe & company ID present & Card Shown to customer

  • Action Taken To Protect Customer’s Property with dust matts and shoe covers

  • Work Area Left Clean & Tidy

  • General Conduct

Engineer & Auditor Signature. I hereby confirm that the above form is a true representation of the responses given and tasks completed.

  • Engineer Signature

  • Auditor Signature

  • Audit Result

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.