CO alarm response record: free blank PDF
Download a printable co alarm response 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 CO alarm response record form
Print the blank record and keep the completed copy with the job. The preview shows the actual blank download.
Blank CO alarm activation response record form
Record scope and contents
England, Wales, Scotland. The appropriately registered gas worker recording the response and any specialist referral.
- Visit: Record reference, Visit date, Jurisdiction, Gas supplied
- Work scope: Appliance work category
- Registered business: Registered business name, Registered business address, Registered business postcode, Registered business telephone, Business Gas Safe no.
- Responsible person as stated: Responsible person, Responsible role, Installation address, Installation postcode
- Report: What was reported, Occupants present at visit, Occupants reported feeling unwell, Medical advice sought
- Emergency attendance: When the engineer arrived, Who attended, Emergency reference, Atmosphere declared safe, Emergency service notified
- Immediate safety actions: Affected appliances turned off, Supply isolated, Doors and windows opened, Site-specific risk assessment done, Risk-assessment notes
- Detectors found
- Appliances considered
- Warning notice and specialist: Unsafe-situation warning notice issued, Linked warning-notice reference, Specialist investigation, Why escalated
- RIDDOR decision: RIDDOR decision, RIDDOR authority, HSE submission reference
- Copy left: Copy left, Retained copy held
- Responsible person receipt: Responsible person signature status, Signatory name as stated, Responsible person signature
- Engineer: Engineer name, Licence number, Engineer signature, Date signed
Primary source for this record · checked 2 October 2026
What the CO alarm response record covers
Record the alarm report, emergency attendance or make-safe status, appliances considered, actions, escalation and handover. This is a response history, not a completed specialist CO investigation or a clearance to re-use an unsafe appliance.
Who needs one
- The appropriately registered gas worker recording the response and any specialist referral.
- Record scope: England, Wales, Scotland.
- Keep the completed record with the source documents, findings and job reference.
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