Gas Safety Checklist

Gas Safety Checklist
Please complete this checklist before the start of the installation event. If there are any unsafe installation, please do not hesitate to seek assistance from a licensed professional.
Name of Gasfitter
First NameLast Name
Business Name
Business Phone Number
Please enter a valid phone number.
Business Email Address
example@example.com
Business Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code

Checklist

	Yes	No
Is the installation gastight compliant with AS/NZS5601.1 Gas installations standards?	1	2
Was the installation of the gas safe and secure?	3	4
Does the appliance have certification?	5	6
Is the room ventilated properly where the appliance will be installed?	7	8
Is it available for servicing and adjustment?	9	10
Are there any visible combustible types of equipment or elements?	11	12
Is there any obstruction?	13	14
Are there any signs of overheating appliances around the area where the gas will be installed?	15	16
Is the flame burner normal?	17	18
Does the appliance have any dust or debris?	19	20
Are the gas supply and burner pressure meter correct?	21	22
Is the heat exchanger in good condition?	23	24
Do the thermostats work?	25	26
Do the ignition devices work?	27	28
Is the gas cylinder in good condition, damaged, or rusty?	29	30
Is the gas cylinder positioned in a secure location?	31	32
Is the gas cylinder located in a well-ventilated position?	33	34
Does the staff know what to do if there's an emergency?	35	36
Is there an available fire extinguisher?	37	38
Does the supply pipes in good condition?	39	40
Does the supply hoses in good condition?	41	42

Any other criteria that is not in the list that you would like to include? If yes, please list them below:
By signing this form, I confirm that the gas is compliant and I make sure that this checklist is up to date. I also confirm that all information I entered in this form is accurate and true to the best of my knowledge.
Gasfitter Signature
Clear
Date Signed
MonthDayYear
Date
Should be Empty: