Commissioning Statement
Commissioning Statement and Check-list
Stove Purchased From:_____________________________________________________
Address:_________________________________________________________________
Telephone Inc area code:____________________________________________________
Installation Date:_____/_____/__________ Stove Name:_________________________
Product Serial Number:________________ Invoice Number:_______________________
Stove installed by:_________________________________________________________
Address:_________________________________________________________________
Telephone Inc area code:____________________________________________________
HETAS Registration Number:________________________________________________
Check-list
Is the flue system the correct length and diameter for stove:
Yes
No
Flue swept and checked for soundness:
Yes
No
Manufacturers clearances adhered:
Yes
No
Smoke spillage test performed on stove:
Yes
No
Stove controls fully explained to end user:
Yes
No
Correct fuels explained to end customer:
Yes
No
CO Alarm fitted and tested:
Yes
No
Instruction booklet & HETAS certificate handed to end user:
Yes
No
Signature:__________________________ Print Name:___________________________
GB12A Issue 2
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