Template

Gas Servicing Record Checklist

by Christopher Weiser, from the Community

10+

Document gas safety checks across properties with this Gas Servicing Record. Capture client details, technician credentials, leakage test results, appliance make and model, certification, installation and ventilation checks, burner pressure, ignition performance, flue condition, carbon monoxide testing, and PTR valve checks. Record outcomes, faults, required actions, quotes, and compliance with ASNZS 5601 and AS 4575, plus notes for each appliance and technician observations.

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Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
Gas Servicing Record Form
This gas servicing record template helps licensed gasfitters document service work in line with Victorian Building Authority requirements. Capture details of the gasfitter and supervising gasfitter, vendor information, and the site and date of work. Record appliance make, model, gas type, and complete AS 4575 Appendix E checks, including certification, installation to AS/NZS 5601, securing, leak testing, pressures, ignition, burner performance, and combustion readings. Note exhaust fans, calibration details, and spillage tests. Finish with declarations and signatures for compliance and record keeping.
by Alex Perkins, from the Community
Downloads: 10+
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Template
Gas Heater Service Checklist
This residential gas heater service checklist helps technicians and inspectors assess appliance condition and safety. Record location, date, and technician details, then follow guided steps to clean and adjust the heater, clean filters and the pilot light, and check ventilation. Test gas pressure (KPA) and conduct carbon monoxide readings, attaching photos of measurements. Capture manufacturer, model, year, and a photo of the model number, and note whether the unit is flued or unflued. Document any damage with photos, current condition, and corrective actions. Verify compliance with AS/NZS 5601 and indicate non-compliance or variations as needed. The template supports image capture and structured record-keeping for consistent, safe servicing.
by Juan Hart, from the Community
Downloads: 0
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Template
NCC Commercial Gas Servicing Checklist
This commercial gas servicing checklist helps technicians inspect and document boiler and burner performance. Record CO2 levels, CO ppm, combustion efficiency, flue gas temperatures, gas rate, inlet and burner pressures, and confirm interlocks. Verify flues and terminations, ventilation requirements, electrical installation, safety valves, and pipework. Perform let-by and tightness tests, flue flow and spillage tests, and confirm safety devices and controls before approval.
by Mark Mahoney, from the Community
Downloads: 0
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Template
Liberty Gas Quality Audit Form
This Liberty Gas Quality Audit Form helps engineers verify safe, compliant gas installations. Use it to record preliminary electrical checks, meter condition, correct labels and pipe sleeving, tightness testing, regulator and appliance pressures, flue integrity and termination, carbon monoxide readings and ventilation, burner condition, safety devices, and gas rate. It also covers documentation such as benchmark and landlord gas safety records, plus health and safety practices, PPE, first aid, fire extinguishers, and customer satisfaction to ensure safe completion.
by Mat Smith, from the Community
Downloads: 20+
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Gas Servicing Record Form

This gas servicing record template helps licensed gasfitters document service work in line with Victorian Building Authority requirements. Capture details of the gasfitter and supervising gasfitter, vendor information, and the site and date of work. Record appliance make, model, gas type, and complete AS 4575 Appendix E checks, including certification, installation to AS/NZS 5601, securing, leak testing, pressures, ignition, burner performance, and combustion readings. Note exhaust fans, calibration details, and spillage tests. Finish with declarations and signatures for compliance and record keeping.

by Alex Perkins, from the Community

10+

Get

Template

Gas Heater Service Checklist

This residential gas heater service checklist helps technicians and inspectors assess appliance condition and safety. Record location, date, and technician details, then follow guided steps to clean and adjust the heater, clean filters and the pilot light, and check ventilation. Test gas pressure (KPA) and conduct carbon monoxide readings, attaching photos of measurements. Capture manufacturer, model, year, and a photo of the model number, and note whether the unit is flued or unflued. Document any damage with photos, current condition, and corrective actions. Verify compliance with AS/NZS 5601 and indicate non-compliance or variations as needed. The template supports image capture and structured record-keeping for consistent, safe servicing.

by Juan Hart, from the Community

Get

Template

NCC Commercial Gas Servicing Checklist

This commercial gas servicing checklist helps technicians inspect and document boiler and burner performance. Record CO2 levels, CO ppm, combustion efficiency, flue gas temperatures, gas rate, inlet and burner pressures, and confirm interlocks. Verify flues and terminations, ventilation requirements, electrical installation, safety valves, and pipework. Perform let-by and tightness tests, flue flow and spillage tests, and confirm safety devices and controls before approval.

by Mark Mahoney, from the Community

Get

Template

Liberty Gas Quality Audit Form

This Liberty Gas Quality Audit Form helps engineers verify safe, compliant gas installations. Use it to record preliminary electrical checks, meter condition, correct labels and pipe sleeving, tightness testing, regulator and appliance pressures, flue integrity and termination, carbon monoxide readings and ventilation, burner condition, safety devices, and gas rate. It also covers documentation such as benchmark and landlord gas safety records, plus health and safety practices, PPE, first aid, fire extinguishers, and customer satisfaction to ensure safe completion.

by Mat Smith, from the Community

20+

Get

Gas Servicing Record Checklist

About author

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Gas Servicing Record Form

Gas Heater Service Checklist

NCC Commercial Gas Servicing Checklist

Liberty Gas Quality Audit Form

You might also like

Gas Servicing Record Form

Gas Heater Service Checklist

NCC Commercial Gas Servicing Checklist

Liberty Gas Quality Audit Form