THIS FORM IS FOR TRAINING PURPOSES ONLY - IT IS NOT A VALID SAFETY CERTIFICATE
My Name
First Name
Last Name
College/Centre Name
Supervising Engineer Details
Name
Gas Licence
Gas Registration
Date
-
Day
-
Month
Year
Date
Inspection Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Gas Meter & Pipework Installation, Inspection and Testing
Details
Pass / Fail
GIUSP Category
ECV Accessible, Operational, Falls by 90 deg to off & , Labelled
Anaconda Condition, Meter Regulator Condition, and Tamper Proof Seal Secure
Meter Support, Stable and Secure
Meter Emergency Label Present and Correct
PEB (Equipotential Bonding) Visible within 600 mm of gas meter (consumer side) & before first tee
Cooker Lids up
Pilot Lights Extinguished & Elec Boilers Turned Down, Service Valves Open
Is IV (Installation Volume) less than 0.035 m3
(attach calculations where required)
Gas Meter Type
Max Gas Pipe Size
Existing Appliances Connected ?
Allowable Drop During 2 Min Gas Tightness Test
Manometer Calibrated and Zero'd
Let By Test 1 minute at 7-10mb (perceptible movement 0.25)
1 Minute Stabilisation Peiord at 20 to 21 mbar
2 Minute Gas Tightness Test at 20 to 21 mbar & Result
Where work is carried out using a heat source the gas meter must be decommissioned. Was this done ?
Where work is carried out that exposes the pipework to atmospheric pressure a purge must be completed. Please state purge volume and safe purge completed or NA
Relight All Appliances and check (Suitable Location, Clearances, Signs of Distress, Ventilation & Fluing to Standards)
Attach Warning Notice Where Required (Attached Yes/No/NA)
Faults Founds and Classification
Your Signature
Email: Copy of Cert
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