What is the gas safety record form template?
A gas safety check produces a lot of numbers in a short visit: pressures, CO and CO2 readings, ratios, test results for each appliance. Paper pads and carbon copies get damp, lost or hard to read, and landlords chase their copy for weeks.
This two-page record starts with the engineer, company and registration number, the date, the property address, the landlord or agent and the occupier, and the reason for the visit, from an annual landlord safety check to a fault visit. Appliance 1 records the appliance, location, make and model, flue type, whether it belongs to the landlord and whether it was serviced. Appliance 2 is optional, and its questions only appear once an appliance is chosen. Further appliances can be attached.
Page two holds the readings for each appliance: operating pressure, CO, CO2, the CO/CO2 ratio, flue and safety checks, and whether it is safe to use. Installation checks follow. When any appliance or part of the installation is unsafe, the form asks what's wrong, how it's classified, what action was taken, the warning notice number and who received it. Signatures complete the record, which is filed as a PDF in your FileIt vault.
- Best for
- Gas engineers, heating firms and letting agents' contractors
- Filled in by
- The engineer on site
- Time to complete
- About 10 minutes per property
- Includes
- Two appliance blocks, combustion readings, flue and installation grids, warning notice fields and two signatures
Who uses a gas safety record form?
- Annual landlord gas safety checks across a rental portfolio
- Boiler services with combustion analysis
- Commissioning a newly installed boiler or water heater
- Recording an unsafe appliance found on a fault visit
- Letting agents collecting checks from several contractors
- Keeping a dated history of checks per property
Questions on this gas safety record form
45 questions over 2 pages · includes signature, file upload, conditional questions, multiple pages, ratings.
1 Property & appliances
- Engineer*
- Company
- Registration or licence number*
- Date of check*
- Record reference
- Property address*
- Landlord, agent or owner
- Their email
- Occupier
- Reason for the visit* Annual landlord safety check · Service · Installation or commissioning · Fault visit
- Appliance* Boiler · Gas fire · Cooker or hob · Water heater · Warm-air heater · Other
- Location*
- Make and model
- Flue type Room-sealed · Open flue · Fanned flue · Flueless
- Landlord's appliance?
- Serviced on this visit?
- Appliance Boiler · Gas fire · Cooker or hob · Water heater · Warm-air heater · Other
- Location* asked only when it applies
- Make and model asked only when it applies
- Flue type asked only when it applies Room-sealed · Open flue · Fanned flue · Flueless
- Further appliances
2 Readings & results
- Operating pressure (mbar)
- CO reading (ppm)
- CO2 (%)
- CO/CO2 ratio
- Flue and safety checks* Pass · Fail · N/A
- Appliance 1 safe to use?* Safe · Unsafe
- Operating pressure (mbar) asked only when it applies
- CO reading (ppm) asked only when it applies
- CO2 (%) asked only when it applies
- CO/CO2 ratio asked only when it applies
- Flue and safety checks asked only when it applies Pass · Fail · N/A
- Appliance 2 safe to use?* asked only when it applies Safe · Unsafe
- Installation checks* Pass · Fail · N/A
- Was any appliance or part of the installation unsafe?*
- What is unsafe?* asked only when it applies
- Classification* asked only when it applies Immediately dangerous · At risk
- Action taken* asked only when it applies Disconnected and labelled · Turned off with permission · Responsible person refused permission
- Warning notice number* asked only when it applies
- Notice given to* asked only when it applies
- Other defects and advice
- Photos
- Next check due
- Engineer signature*
- Received by (occupier or landlord)
The gas safety record form, page by page
1 Property & appliances
Engineer, Registration or licence number and Date of check are required, with company and a record reference. Property address is required; the landlord, agent or owner, their email and the occupier are optional. Reason for the visit has four choices. For each appliance: Appliance (boiler, gas fire, cooker or hob, water heater, warm-air heater or other), Location, Make and model, Flue type (room-sealed, open, fanned or flueless), Landlord's appliance? and Serviced on this visit? Leave Appliance 2 blank when there's only one.
2 Readings & results
Each appliance has Operating pressure (mbar), CO reading (ppm), CO2 (%) and CO/CO2 ratio, then a Flue and safety checks grid covering the flow or spillage test, flue condition and termination, ventilation and safety devices, and Appliance safe to use? The Installation checks grid covers tightness, pipework, emergency control valve access, protective bonding and CO alarms. A yes to Was any appliance or part of the installation unsafe? opens What is unsafe?, Classification, Action taken, Warning notice number and Notice given to. Other defects, photos, the next check due date and both signatures finish the record.
Make the template yours
- Rename the classifications and actions to match your registration body's procedure
- Add a third appliance block if many properties have three
- Add a heat input or burner pressure reading if you record one
- File records into a vault folder per landlord or property
- Add the letting agent's address to notifications for their properties
Tips for a better gas safety record form
- Enter readings straight from the analyser printout
- Photograph the analyser screen and any defects
- Explain an unsafe situation to the occupier in person before you leave
- Set the next check due date while you're still on site
- Ask the occupier to sign for the record on your phone
Every response becomes a PDF in your vault
Each record is filed as a signed PDF in your FileIt vault with photos attached, and you're emailed for every one. When you enter the landlord's email, they can be sent a copy.
The Responses table lets you search by address, landlord or engineer, and the CSV export shows next-check-due dates across your properties.
- Start from this template. It opens in the FileIt Forms designer — change any question, add pages, set the rules for when questions appear.
- Share it. Turn on a public link, or send it to people by email, each with their own link. They don’t need a FileIt account.
- Get the answers as PDFs. Each response is saved as a PDF in the vault folder you choose, with uploaded files attached — and listed in a Responses table you can export to CSV.
Gas safety record form: frequently asked questions
Is this gas safety record free?
Yes. It's a starter template in the FileIt Forms app, and you can change every question.
Is it an official certificate?
No. It's a general starting point. Check what your registration body and local regulations require, and edit the questions so the record includes everything they ask for.
How many appliances does it cover?
Two on the form. Appliance 2's questions appear only once you choose it, and details for further appliances can be attached.
When do the warning notice questions appear?
When you answer yes to Was any appliance or part of the installation unsafe?
Can the occupier sign on my phone?
Yes. There's an optional signature for the occupier or landlord to confirm they received the record.