You are on page 1of 1

DocuSign Envelope ID: 38A053E9-F748-42F4-B841-7D2536D1AC52

Domestic Landlord / Homeowner Gas Safety Record


Date: 1st March 2023 Ref: Rsssell/67
Gas Safe Reg No: 213145 Serial no: GAUK00744966

Details of Registered Business Details of Landlord / Homeowner (or agent where appropriate) Details of Site
Name: A G Heating&Plumbing Name: Hamlet Homes Name: Sonia Kaur
Address: 50 Sewell Avenue Address: 78 Address: 67
Oxford Road Russell street
Wokingham Reading Reading
Berkshire Berkshire Berkshire
Postcode: RG411NS Postcode: RG1 7LJ Postcode: RG17XG
Contact Number: 07795516622 Contact Number: 01184439367 Contact Number:

Appliance Details Final check results


Location Type Manufacturer Model Owned by Landlord Appliance Inspected? Flue Type Outcome of gas tightness test Pass
1 Kitchen Boiler Vaillant Eco tec plus 637 Yes Yes Room sealed Is the main protective equipotential bonding satisfactory? Yes
fan flue Is the emergency control accessible? Yes
Inspection Details Satisfactory visual inspection of gas installation pipework? Yes
Operating Pressure Safety devices Satisfactory Visual condition of Flue operation Combustion Was appliance Is appliance safe CO alarm fitted and working? Yes
(mbars) or heat input operating correctly? Ventilation? flue & termination. checks. analyser reading. serviced? to use?
(kW/h) Notes
1 37 kW/h Yes Yes Pass Pass 0.0003 No Yes

Label & Warning Combustion Performance Readings


Defects Identified Remedial Work Details Notice Low High
CO CO2 Ratio CO CO2 Ratio
1 No N/A N/A N/A N/A N/A N/A

Record Issued By: Received By:


Next Inspection Is Due Before: Signature: Signature:
Name
1st March 2024 Position Date 1st March 2023

Gas Engineer Sandeep Gehlot


Gas Safe Licence Date 1st March 2023

This record can be used to document the outcome of checks and tests required by The Gas Safety (Installation and Use) Regulations 1998 as amended by the Gas Safety (Installation and Use) (Amendment) Regulations 2018. Some of the outcomes are as a result of visual inspection only and are
recorded where appropriate. Unless specifically recorded no detailed inspection of the flue lining, construction or integrity has been performed. Registered Business / engineer details can be checked at www.gassaferegister.co.uk or by calling 0800 408 5500.

Gas App Uk 2023


Powered by TCPDF (www.tcpdf.org)

You might also like