11 Sandycroft Avenue, Wythenshawe M22 9AL
18/12/23
BOILER
18/12/23
STOP TAP
18/12/23
SMOKE ALARM
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Stop Tap Survey History
STOP TAP
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18/12/23
Last Inspection
18/12/24
Next Safety Check
Kitchen
Location of stop tap
Yes
Stop tap in good condition
Pass
Inspection Result
Remedial action required
SMOKE ALARM
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18/12/23
Last Inspection
18/12/24
Next Safety Check
Bottom of stairs
Location - Smoke Alarm 1
Top of stairs
Location - Smoke Alarm 2
Location - Smoke Alarm 3
Location - Smoke Alarm 4
Location - Smoke Alarm 5
Location - Smoke Alarm 6
Pass
Inspection Result
All working
Remedial action required
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Smoke Alarm Survey History
GAS CHECKS
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18/12/23
Last Inspection
18/12/24
Next Safety Check
Yes
Meter/emergency control accessible
Yes
Visible equipotential
bonding at meter
Yes
Is gas installation
safe to use
Yes
Gas meter installation pipework satisfactory
Yes
Gas installation tightness test satisfactory
Gas
Supply fuel type
Gas/LPG
Kitchen
Location
Combi
Boiler type
Baxi
Make
Xxx
Model
Yes
Ventilation satisfactory
RS
Flue type
Yes
Safety controls working
Pass
Flue visual check
Yes
Flue termination satisfactory
Pass
Flue integrity check
Pass
Spillage test satisfactory
Pass
Flue flow satisfactory
0.00001
Working pressure/heat input
100
Results CO/CO2 ratio
Yes
Flue gas analysis performed
Yes
Appliance safe to use
N/a
Reason code
No
Warning notice to be issued
Yes
CO alarm working
Pass
Inspection result
Not applicable
Remedial action required
N/A
Location
N/A
Make
N/A
Model
N/A
Flue type
N/A
Safety controls working
N/A
Ventilation satisfactory
N/A
Working pressure/heat input
N/A
Warning notice to be issued
N/A
Appliance safe to use
N/A
Inspection result
N/A
Remedial action required
N/A
Location
N/A
Make
N/A
Model
N/A
Flue type
N/A
Safety controls working
N/A
Ventilation satisfactory
N/A
Working pressure/heat input
N/A
Warning notice to be issued
N/A
Appliance safe to use
N/A
Inspection result
N/A
Remedial action required
N/A
Location
N/A
Make
N/A
Model
N/A
Ventilation satisfactory
N/A
Flue type
N/A
Safety controls working
N/A
Flue visual check
N/A
Flue termination satisfactory
N/A
Flue integrity check
N/A
Spillage test satisfactory
N/A
Flue flow satisfactory
N/A
Working pressure/heat input
N/A
Appliance safe to use
N/A
Warning notice to be issued
N/A
Inspection result
N/A
Remedial action required
John King
Engineer name
Gas Engineer Details
Brand
Company Gas Safe Reg No
18/12/23
Date of survey
Email for certificate copy
12345
Gas Safe Card Serial No
I certify that I have carried out the work on the date of survey. The Customer/ Tenant/ Landlord/ Responsible Person has been informed of any faults/remedial to bring the installation(s) up to standard.
GAS SAFETY CHECKS
BOILER
HOB
OVEN
FIRE
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Boiler Survey History
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Gas Safe Certificate