The Gas Installation Safety Record Form Template UK is offered in multiple formats, including PDF, Word, and Google Docs, and features customizable and ready-to-print samples.
Gas Installation Safety Record Form Template UK Editable – PrintableSample
Gas Installation Safety Record Form Template UK 1. Client Information 2. Gas Installer Information 3. Installation Details 4. Installed Equipment Information 5. Safety Checks Performed 6. Test Results 7. Recommendations 8. Client Acknowledgment 9. Declaration and Signatures
PDF
WORD
Examples
[Project Name]
[Project Address]
[Installation Date]
[Name of the Client]
[Client’s Contact Number]
[Client’s Email]
[Name of the Installer/Contractor]
[Installer’s ID]
[Installer’s Contact Number]
[Installer’s Email]
This record details the gas installation process completed on [Installation Date], ensuring compliance with UK gas safety regulations.
The following equipment has been installed:
1. [Description of Appliance 1]
2. [Description of Appliance 2]
3. [Description of Appliance 3]
The installer has conducted the following safety checks:
1. Gas tightness test: [Passed/Failed]
2. Flue flow test: [Passed/Failed]
3. Operating pressure test: [Passed/Failed]
I hereby declare that the installation conducted complies with the Gas Safety (Installation and Use) Regulations 1998 and is safe for use.
For future maintenance, it is recommended that a service check is conducted annually by a qualified gas engineer.
[Signature of the Installer]
[Name of the Installer]
[Signature of the Client]
[Name of the Client]
[Project Name]
[Installation Location]
[Completion Date]
[Client’s Name]
[Client’s Phone Number]
[Client’s Email Address]
[Installer’s Full Name]
[Installer’s Registration Number]
[Installer’s Contact Information]
This record outlines the gas installation completed on [Completion Date], in adherence to current gas safety practices.
The following systems were installed:
a) [System Description 1]
b) [System Description 2]
c) [System Description 3]
The following safety evaluations were carried out:
a) Gas pressure test: [Result]
b) Combustion check: [Result]
c) Ventilation analysis: [Result]
The installation meets the requirements of the Gas Safety (Installation and Use) Regulations and is confirmed safe.
It is advised that routine inspections are conducted every 12 months by a registered gas engineer.
[Installer’s Signature]
[Installer’s Name]
[Client’s Signature]
[Client’s Name]
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