9 Sandycroft Avenue, Wythenshawe, MANCHESTER M22 9AL
BOILER
27/8/24
STOP TAP
27/8/24
SMOKE ALARM
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Stop Tap Survey History
STOP TAP
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27/8/24
Last Inspection
27/8/25
Next Safety Check
Cupboard next to sink
Location of stop tap
Yes
Stop tap in good condition
Pass
Inspection Result
Remedial action required
SMOKE ALARM
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27/8/24
Last Inspection
27/8/25
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
Pass
Inspection Result
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