Gas appliance service record: free blank PDF
Download a printable gas appliance service record for England, Wales, Scotland. The PDF contains the record sections shown below and writing space for the actual findings.
Download the blank printable PDF for free.
Free blank Gas appliance service record form
Print the blank record and keep the completed copy with the job. The preview shows the actual blank download.
Blank Gas appliance service record form
Record scope and contents
England, Wales, Scotland. The Gas Safe registered individual with the fuel, appliance category and service scope.
- Record details: Record reference, Service date, Next service due before, Type of visit, Fuel
- Work location: Work jurisdiction
- Registered business: Registered business name, Registered business address, Registered business postcode, Registered business telephone, Business Gas Safe no.
- Installation: Installation address, Installation postcode, Site contact name
- Appliance identity: Appliance category, Appliance type, Location, Make, Model, Flue type
- Gas fire checks: Glass and seals inspected, Fuel-effect position, Guard and hearth inspected
- Cooker and hob checks: Stability device inspected, Flexible connection inspected, Clearances inspected
- Water heater checks: Flue and termination inspected, Temperature control inspected
- Warm-air heater checks: Filters inspected, Ducts and returns inspected
- Safety checks: 26(9)(c) method, Operating pressure, Heat input, Combustion performance (reg 26(9)(ca)), Safety devices operating, Ventilation satisfactory, Flue effectiveness, Spillage inspected, Appliance tightness result
- Safety outcome: Appliance safe to use, Defects and remedial action, Warning notice issued, Linked warning notice reference, Person notified, Owner told if different
- Engineer: Engineer name, Licence number, Engineer signature, Date signed
Primary source for this record · checked 2 October 2026
What the Gas appliance service record covers
Record the service of a non-boiler gas appliance, appliance identification, checks, measured findings, parts and next action. Use the gas boiler service record for a boiler. This record follows the work performed rather than replacing the manufacturer's service instructions.
Who needs one
- The Gas Safe registered individual with the fuel, appliance category and service scope.
- Record scope: England, Wales, Scotland.
- Keep the completed record with the source documents, findings and job reference.
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