Gas work record: free blank PDF
Download a printable gas work 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 work record form
Print the blank record and keep the completed copy with the job. The preview shows the actual blank download.
Blank Gas work record form
Record scope and contents
England, Wales, Scotland. The Gas Safe registered individual with the fuel, appliance and activity scope for the actual work.
- Work: Record reference, Date of work, Type of work, Fuel, Jurisdiction, Manufacturer instruction reference used, Work carried out
- Work scope: Appliance work category
- Registered business: Registered business name, Registered business address, Registered business postcode, Registered business telephone, Business Gas Safe no.
- Installation address: Installation address, Installation postcode
- Named site contact: Site contact name, Site contact role
- Appliances worked on
- Regulation 26(9) examinations: Flue effectiveness examined, Combustion air supply examined, 26(9)(c) method, Pressure or heat input, Safe functioning examined, Safe to use, Defects and actions, Linked warning notice, 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 work record covers
Record the gas work performed, appliances affected, installation details and the examinations carried out after work. Keep the actual findings and sign-off with the job. This is a work record rather than an annual landlord safety record or a tightness-test model form.
Who needs one
- The Gas Safe registered individual with the fuel, appliance and activity scope for the actual work.
- Record scope: England, Wales, Scotland.
- Keep the completed record with the source documents, findings and job reference.
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