9 Mullacre Road, Wythenshawe M22 8DB
21/12/23
BOILER
21/12/23
STOP TAP
21/12/23
SMOKE ALARM
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Stop Tap Survey History
STOP TAP
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21/12/23
Last Inspection
21/12/24
Next Safety Check
Behind washing machine
Location of stop tap
Yes
Stop tap in good condition
Pass
Inspection Result
Remedial action required
SMOKE ALARM
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21/12/23
Last Inspection
21/12/24
Next Safety Check
Top of stairs
Location - Smoke Alarm 1
Bottom 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
Remedial action required
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Smoke Alarm Survey History
GAS CHECKS
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21/12/23
Last Inspection
21/12/24
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
555
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
0.000001
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
None
Remedial action required
Kitchen
Location
NEF
Make
5556
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
Kitchen
Location
NEF
Make
555
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
Paragon
Make
5556
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
Joe Smith
Engineer name
Gas Engineer Details
300333
Company Gas Safe Reg No
21/12/23
Date of survey
Email for certificate copy
123456
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