Gas Safety Certificate (CP12) - Building Group Surveys

Property & Landlord Details

Property Address *

Landlord/Duty Holder Name *

Landlord Address

Property Type *

Inspection Date *

Next Inspection Due *

Tenant Name (if occupied)

Gas Supplier

Gas Safe Engineer Details

Engineer Name *

Gas Safe Registration Number *

Company Name

Engineer/Company Address

Contact Phone

Contact Email

Gas Installation Details

Gas Meter Location *

Gas Meter Type

Emergency Control Valve Location

Pipework Material

Installation Description

Gas Appliances & Safety Checks

Safety Assessment Results

Each gas appliance must be assessed for safety in accordance with Gas Safety (Installation and Use) Regulations 1998

Gas Appliance 1

Appliance Type *

Location *

Make/Manufacturer

Model Number

Input Rating (kW)

Flue Type

Safety Assessment *

✅

SATISFACTORY
Safe to use

⚠️

AT RISK
Unsafe situation

🚨

IMMEDIATELY DANGEROUS
Disconnected

Operating Pressure (mbar)

Combustion Analysis Result

CO Reading (ppm)

Ventilation Adequate

Defects Identified

Remedial Action Taken

Installation Safety Checks

Mandatory Safety Tests

The following checks are required under Gas Safety (Installation and Use) Regulations 1998

Pipework Pressure Test

Installation Tightness Test

Test Pressure (mbar)

Test Duration (minutes)

Emergency Procedures Explained

Warning Notice Issued

Additional Safety Notes

Certificate Declaration

Overall Safety Assessment *

Recommended Actions

Certificate Issue Date *

Certificate Expiry Date *

Engineer Digital Signature *

Copy Provided to Landlord

Copy Provided to Tenant