Homeowner gas safety check record: free blank PDF
Download a printable homeowner gas safety check 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 Homeowner gas safety check record form
Print the blank record and keep the completed copy with the job. The preview shows the actual blank download.
Blank Homeowner gas safety check form
Record scope and contents
England, Wales, Scotland. The Gas Safe registered individual with the scope for the appliances and fuel checked.
- Record details: Record reference, Date checked, Jurisdiction, Fuel
- Registered business: Registered business name, Registered business address, Registered business postcode, Registered business telephone, Business Gas Safe no.
- Owner-occupier: Owner-occupier name as stated, Installation address, Installation postcode
- Appliances and flues checked
- Installation checks: Pipework visual check, ECV access, Tightness test result, Bonding satisfactory
- Defects and actions
- Outcome: Safe after check
- Engineer: Engineer name, Licence number, Engineer signature, Date signed
Primary source for this record · checked 2 October 2026
What the Homeowner gas safety check record covers
Record an owner-occupier's appliance and flue checks, defects, actions and sign-off. A voluntary homeowner check and a landlord's statutory safety record serve different purposes; choose the record for the actual premises and customer.
Who needs one
- The Gas Safe registered individual with the scope for the appliances and fuel checked.
- Record scope: England, Wales, Scotland.
- Keep the completed record with the source documents, findings and job reference.
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