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GAS SAFETY
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STOP TAP
SMOKE ALARM
STATUS
64 High Bank, Gorton, Manchester M18 8UL
15/1/24
BOILER
2/2/24
STOP TAP
15/1/24
SMOKE ALARM
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Stop Tap Survey History

STOP TAP

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2/2/24

Last Inspection

2/2/25

Next Safety Check

under sink

Location of stop tap

Yes

Stop tap in good condition

Pass

Inspection Result

Remedial action required

SMOKE ALARM

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15/1/24

Last Inspection

15/1/25

Next Safety Check

Kitchen

Location - Smoke Alarm 1

Location - Smoke Alarm 2

Location - Smoke Alarm 3

Location - Smoke Alarm 4

Location - Smoke Alarm 5

Location - Smoke Alarm 6

Pass

Inspection Result

None

Remedial action required

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Smoke Alarm Survey History

GAS CHECKS

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15/1/24

Last Inspection

15/1/25

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

Gassage

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

18mb

Working pressure/heat input

0.001

Results CO/CO2 ratio

Yes

Flue gas analysis performed

Yes

Appliance safe to use

Na

Reason code

No

Warning notice to be issued

Yes

CO alarm working

Pass

Inspection result

None

Remedial action required

Kitchen

Location

AEG

Make

Yule

Model

FL

Flue type

Yes

Safety controls working

Yes

Ventilation satisfactory

18mb

Working pressure/heat input

No

Warning notice to be issued

Yes

Appliance safe to use

Pass

Inspection result

Mone

Remedial action required

Kitchen

Location

AEG

Make

Dsa

Model

FL

Flue type

Yes

Safety controls working

Yes

Ventilation satisfactory

18mb

Working pressure/heat input

No

Warning notice to be issued

Yes

Appliance safe to use

Pass

Inspection result

None

Remedial action required

Living Room

Location

Pureglow

Make

Derby

Model

Yes

Ventilation satisfactory

OF

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

18mb

Working pressure/heat input

Yes

Appliance safe to use

No

Warning notice to be issued

Pass

Inspection result

Remedial action required

Neil Cousins

Engineer name

Gas Engineer Details
123456

Company Gas Safe Reg No

15/01/24

Date of survey

Email for certificate copy

333030

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.

Email for certificate copy

Joanne Holden

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

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