DLE Safety Check

CUSTOMER REVIEW:

I have been told what to do if I smell a gas or otherwise suspect a gas leak and have been told where to shut the gas supply off at the tank or cylinder. I have smelled propane gas and can detect its odor I have received the Consumer Safety Information and have been told to read and share with all family members and/or others living in the household I had gas system deficiencies and or corrections,if any clearly explained to me I am satisfied with the service work performed I certify the number of appliances above is complete

TECHNICIAN REVIEW:

Performed Odor Test:

YES NO

Odor Detected:

YES NO

Consumer Safety Information supplied to customer:

YES NO

Pictures taken of installation or Red Tagged Item(s):

YES NO

	TWIN STAGE	HP 1st STAGE
MFR:
MODEL:
REGULATOR DATE CODES:
REGULATOR CONDITION:
REG. VENT POSITION:
FLOW PRESSURE:
LOCK-UP PRESSURE:
PIPING MATERIAL:
PIPING SIZE:

	LOW PRESS. 2nd	LOW PRESS. 3rd
MFR:
MODEL:
REGULATOR DATE CODES:
REGULATOR CONDITION:
REG. VENT POSITION:
FLOW PRESSURE:
LOCK-UP PRESSURE:
PIPING MATERIAL:
PIPING SIZE:

	INITIAL	RETEST
START PRESS:
END PRESS:
START TIME:
END TIME:
TIME HELD:
PRESS HELD:

	INITIAL	RETEST
START PRESS:
END PRESS:
START TIME:
END TIME:
TIME HELD:
PRESS HELD:

Piping / Regulator Operation/ Condition

Tanks:

HIGH PRESSURE SYSTEM LEAK CHECKS

Appliances:

LOW PRESSURE SYSTEM LEAK CHECKS

Complete this check?