GAS INSTALLER : (Trading Title) AKAA PLUMBING AND HEATING OTN - 6508

LANDLORD/HOME OWNER GAS Name : MD KAWSER ALI Gas Installer Ref.No : 5134317
SAFETY RECORD Address : 152 HAGDEN LANE Gas Safe Reg. No : 625640
This inspection is for gas safety purposes only in accordance with the current edition of the Gas WATFORD Date of issue : 2021-08-28
Safety(Installation and use) Regulations. Flues were inspected visually and checked for satisfactory evacuation Post Code : WD187UH Time of issue : 11:11
of products of combustionl. Adetailed internal inspection of the flue integrity, construction and lining has not
been carried out. Tel : 07495558333 Issued by (print name): Md Ali
TENANT/HOME OWNERS DETAILS LANDLORD/AGENT OWNERS DETAILS
Tenant/Home Owner Name : Madalina Pemb Landlord/Agent Name : Mr Darren
Property Address : 10 cheriton lodge Pembroke road HA4 8FB Address :
Phone No : +447444470301 Phone No : +447599945190
Post Code : HA4 8FB Post Code :
Tenant/Home Owner present during inspection : Yes [Tenant] Landlord/Agent present during inspection : Yes [Landlord]
APPLIANCE DETAILS
Location Appliance Type Make Model Landlords Appliance Appliance Inspected Flue Type
Utility room Boiler Baxi Duo Tec 24 combi Yes Yes RS
Kitchen Gas hob ZANUSSI Unknown Yes Yes FL
NA
NA
CARBON MONOXIDE: Drowsiness, headaches or nausea when a gas appliance is running could be Carbon Monoxide (CO) Poisoning. Turn the appliance of IMMEDIATELY and seek expert help
CO Alerm(s) fitted : No CO Alerm(s) tested : No Make/Model : Date of manufacture : (if older than 5 years alarm(s) may need replacing)

INSPECTION DETAILS
Operating pressure Initial combustion Final combustion Vantilation Visual condition of flue/
Safety device's Flue performance Appliance Appliance safe
inmbar or heat input in analyer reading analyer reading provision chimney and termination
correct operation checks serviced to use
kw (if applicable) (if applicable) satisfactory satisfactory
20.00 mbar NA 0.0005 Yes Yes Yes NA No Yes
19.50 mbar NA NA Yes Yes NA NA No Yes
NA
NA
DEFECTS IDENTIFIED Gas installation pipework satisfactory visual inspection Yes/No Yes NEXT
Emergency Control Valve Accessible Yes/No Yes SAFETY
Satisfactory gas tightness test Yes/No/NA Yes
CHECK DUE
WITHIN 12
Protective equipotential bonding satisfactory Yes/No No
MONTHS
REMEDIAL ACTION TAKEN
This safety Record issued by :Signed _____________________________
Print Name : Md Kawser Ali
Received by :Signed _____________________________ (Tenant/Landlord/Agent/ Home Owner )
Date appliance's / Flue's checked : 2021-08-28