Gas safety record form

A complex worksheet simplified for mobile

This is a detailed worksheet which uses predefined data and conditional fields to make data input as easy as possible. The output is identical to a standard paper form and is sent in duplicate colour versions. All data is stored in a searchable database and can be exported as a spreadsheet.

As this is a demonstration form it differs slightly from the application in the following ways: An email address is requested to send the form and your name to complete the data – in the app these fields are determined by user login accounts. You will also be asked to read and agree with the privacy policy.


person


email

Today's date: Sunday, 22 July 2018

Job details


map


phone_in_talk

Is the property rented?

Yes

Landlord details


map


phone_in_talk

Gas installation pipework


YesNo

YesNo

YesNo

YesNo

First appliance details





Type of flue
OFRSFL

Landlord's appliance
YesNo

Appliance inpsected
YesNo

Inspection details




Safety devices working?
YesNo

Satisfactory ventilation
YesNo

Flue condition
PassFailN/A

Flue performance checks
PassFailN/A

Appliance serviced?
YesNo

Appliance safe to use?
YesNo

CO Alarm

Approved CO alarm fitted?
YesNo

Alarm functioning?
YesNo

Defects identified

Warning advice issued
YesNo



Second appliance details

Add a second appliance report





Type of flue
OFRSFL

Landlord's appliance
YesNo

Appliance inpsected
YesNo

Inspection details




Are safety devices working?
YesNo

Satisfactory ventilation
YesNo

Flue condition
PassFailN/A

Flue performance checks
PassFailN/A

Appliance serviced?
YesNo

Appliance safe to use?
YesNo

CO Alarm

Approved CO alarm fitted?
YesNo

Alarm functioning?
YesNo

Defects identified

Warning advice issued
YesNo



Third appliance details

Add a third appliance report





Type of flue
OFRSFL

Landlord's appliance
YesNo

Appliance inpsected
YesNo

Inspection details




Are safety devices working?
YesNo

Satisfactory ventilation
YesNo

Flue condition
PassFailN/A

Flue performance checks
PassFailN/A

Appliance serviced?
YesNo

Appliance safe to use?
YesNo

CO Alarm

Approved CO alarm fitted?
YesNo

Alarm functioning?
YesNo

Defects identified

Warning advice issued
YesNo



Fourth appliance details

Add a fourth appliance report





Type of flue
OFRSFL

Landlord's appliance
YesNo

Appliance inpsected
YesNo

Inspection details




Are safety devices working?
YesNo

Satisfactory ventilation
YesNo

Flue condition
PassFailN/A

Flue performance checks
PassFailN/A

Appliance serviced?
YesNo

Appliance safe to use?
YesNo

CO Alarm

Approved CO alarm fitted?
YesNo

Alarm functioning?
YesNo

Defects identified

Warning advice issued
YesNo



Fifth appliance details

Add a fifth appliance report





Type of flue
OFRSFL

Landlord's appliance
YesNo

Appliance inpsected
YesNo

Inspection details




Are safety devices working?
YesNo

Satisfactory ventilation
YesNo

Flue condition
PassFailN/A

Flue performance checks
PassFailN/A

Appliance serviced?
YesNo

Appliance safe to use?
YesNo

CO Alarm

Approved CO alarm fitted?
YesNo

Alarm functioning?
YesNo

Defects identified

Warning advice issued
YesNo



Additional details


comment

Next Gas Safety due


date_range

Customer acceptance

I confirm that the work has been carried out and finished to my satisfaction


Engineer's job confirmation

I confirm that the work has been completed as detailed

On Sunday, 22 July 2018

Privacy

I have read, understood and agree to the Privacy Policy (opens in a new tab).
Yes, I am happy with your privacy policy

Is it ok to contact you via the email address provided beyond the response to this demo?
YesNo