48 Bucklow Drive, Wythenshawe, MANCHESTER M22 4NB
BOILER
23/8/24
STOP TAP
23/8/24
SMOKE ALARM
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Stop Tap Survey History
STOP TAP
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23/8/24
Last Inspection
23/8/25
Next Safety Check
Kitchen Cupboard side of Sink
Location of stop tap
Yes
Stop tap in good condition
Fail
Inspection Result
Stop Tap above Gas Meter.
Remedial action required
SMOKE ALARM
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23/8/24
Last Inspection
23/8/25
Next Safety Check
Hallway
Location - Smoke Alarm 1
Landing
Location - Smoke Alarm 2
Location - Smoke Alarm 3
Location - Smoke Alarm 4
Location - Smoke Alarm 5
Location - Smoke Alarm 6
Fail
Inspection Result
Brackets in place but Smoke Alarm missing on Landing.
Remedial action required
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Smoke Alarm Survey History
GAS CHECKS
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Last Inspection
Next Safety Check
N/A
Meter/emergency control accessible
N/A
Visible equipotential
bonding at meter
N/A
Is gas installation
safe to use
N/A
Gas meter installation pipework satisfactory
N/A
Gas installation tightness test satisfactory
N/A
Supply fuel type
Gas/LPG
N/A
Location
N/A
Boiler type
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
Results CO/CO2 ratio
N/A
Flue gas analysis performed
N/A
Appliance safe to use
N/A
Reason code
N/A
Warning notice to be issued
N/A
CO alarm working
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
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
N/A
Engineer name
Gas Engineer Details
N/A
Company Gas Safe Reg No
N/A
Date of survey
N/A
Email for certificate copy
N/A
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.
N/A
Email for certificate copy
N/A
Full Name
Resident Details
GAS SAFETY CHECKS
BOILER
HOB
OVEN
FIRE
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Boiler Survey History
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Gas Safe Certificate