Boiler Installation Form Test Company Details Cert no. Engineer Company Address Line 1 Address Line 2 Address Line 3 Address Line 4 Postcode Telephone Number Gas Safe Reg No. ID Card No. Job Address Details Name Address Line 1 Address Line 2 Address Line 3 Address Line 4 Postcode Telephone Number Client / Landlord Details Name Company Address Line 1 Address Line 2 Address Line 3 Address Line 4 Postcode Telephone Number Appliance Details Location Appliance Type Make Model Serial No. GC Number Landlord equipment? Flue type Safety Checks Heat Input (kW/h) Running set point temperature (°C) Safety device(s) correct operation Ventilation in accordance with manufacturer’s recommendation? Combustion Readings High Combustion Readings CO / CO2Ratio CO ppm CO2 % Low Combustion Readings CO / CO2Ratio CO ppm CO2 % Gas Checks Gas Rate (M3/h) Gas tightness satisfactory? Equipotential earth bonding? Standing pressure at gas meter (mbar) Standing pressure at appliance inlet test point (mbar) Working pressure at gas meter with appliance set to max rate (mbar) Working pressure at appliance inlet test point with appliance set to max rate (mbar) Comments Engineers Comments Signatures Issued By Received By Commissioning Date Next service due on or before Submit Generate Certificate Enter your email address so we can send you the completed record. Email Confirm