Safety Inspection Gas Safety Checklist

Safety Inspection Gas Safety Checklist

Client Name:   Property Address:

Inspector Name:   Company:

Contact Phone:   Inspection Date:   Inspection Time:

Recitals

WHEREAS, the Client has requested a comprehensive inspection and safety assessment of gas systems, appliances and associated piping located at the Property identified above; and

WHEREAS, the Inspector is qualified, certified and equipped to perform gas safety inspections, pressure testing and to provide written findings and recommendations in accordance with applicable safety standards and accepted industry practice; and

WHEREAS, the parties desire to document the inspection results, any corrective actions required or completed, and the commercial terms governing the inspection and any ancillary services.

Scope of Work

Inspection Checklist

Meter & Service

Meter accessible and unobstructed     No evidence of leakage at meter

Piping & Valves

Visible corrosion or damage to exposed piping     Manual shutoff valves operable

Appliances

Boiler (if present)     Furnace

Water Heater     Range / Oven

Gas Fireplace     Other (describe)

Venting & Flues

Venting and flues unobstructed and intact     Chimney and vent seals satisfactory

Gas Leak Detection & Pressure Testing

Leak detection performed (soap/water / electronic)     Pressure test passed at time of inspection

Combustion Air & Clearances

Adequate combustion air and clearances observed     Deficiencies noted for corrective action

Findings, Recommendations, and Repairs

Payment Terms

Inspection Fee Amount:

Late Fee:   Payment Due Within:

Term and Termination

Service Start Date:   Service End Date (if applicable):

Termination Notice Period:

Confidentiality

The Inspector and the Client each agree that all non-public information obtained in connection with this inspection, including written reports, testing data, pricing and proprietary inspection techniques, shall be treated as confidential and shall not be disclosed to third parties without prior written consent except as required by law or as required to effectuate necessary repairs. Confidential information does not include information that is or becomes publicly available other than by a breach of this provision.

Governing Law

This Agreement and the interpretation of its terms shall be governed by the laws of the state or jurisdiction where the Property is located. Governing jurisdiction:

Limitation of Liability & Certification

The Inspector shall perform the inspection with reasonable care and in accordance with industry practice. The Client acknowledges that the inspection is a visual, non-invasive examination except where testing has been expressly agreed and documented. The Inspector’s liability for any claim, whether in contract, tort or otherwise, arising out of or related to this inspection and report shall be limited to direct damages not to exceed the total fees paid for the inspection. In no event shall the Inspector be liable for incidental, consequential or punitive damages.

Certification: I certify that the inspection and testing described in this checklist were performed on the date and time stated above, that the information recorded is true and accurate to the best of my knowledge, and that recommendations for corrective action have been provided where safety concerns were identified.

Entire Agreement

This document and any attachments constitute the entire agreement between the Client and the Inspector with respect to the subject matter herein and supersede all prior representations, negotiations and agreements, whether written or oral. Any modification must be in writing and signed by both parties.

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