Gas Safety Certificate (CP12)

Landlord's Gas Safety Record (CP12)

Important: This form is for recording the details of a gas safety inspection conducted by a qualified Gas Safe registered engineer. The engineer is responsible for the accuracy of the inspection and the information provided. Ensure you receive a signed copy from the engineer.

1. Certificate & Property Details

Certificate Number (Engineer Issued)

Date of Issue / Inspection

Address of Installation

2. Landlord / Agent Details

Landlord/Agent Name

Landlord/Agent Address

3. Gas Safe Registered Engineer Details

Engineer's Name

Engineer's Business Name

Gas Safe Register No.

Engineer's Telephone

Engineer's Signature (Confirm on physical copy)

Date of Checks

4. Appliance(s) Checked & Safety Results

Appliance 1

Location

Type

Manufacturer

Model

Op. Pressure / Heat Input

Safety Devices OK?

Ventilation OK?

Flue Performance OK?

Appliance Safe to Use?

5. Defects Identified & Remedial Action

Any defects identified by the engineer:

Remedial action taken or required:

Warning/Advisory Notice Issued? (Number if applicable)

6. Overall Safety Assessment

Engineer's overall assessment of gas installation safety:

7. Tenant Acknowledgement of Receipt

A copy of this Gas Safety Record must be provided to the tenant(s) within 28 days of the check, and to new tenants before they move in. It is recommended to obtain a signature acknowledging receipt.

Tenant Signature (acknowledging receipt) Date of Receipt by Tenant