Health and Safety
Health and Safety at Work etc Act 1974
The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013
Report of a dangerous gas fitting
About you and your organisation
*Your Phone No
Address Line 1
(eg building name)
Address Line 2
Address Line 3
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About the incident
*On what date was the dangerous gas fitting found?
*Where was the dangerous gas fitting found?
*In which local authority is the address where the dangerous gas fitting was found?
Please refer to the help for guidance on the local authority
*Was it in a building?
If yes, what type of building
And in what room?
*Was the fault repaired at the time?
*If not, were the premises made safe by disconnection or contact
with National Grid's emergency centre for them to disconnect?
*Were the premises rented?
What is the name of the person living in the premises?
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Details of the landlord or their managing agent
Was the landlord or their managing agent notified about the faults?
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About the dangerous appliance or gas fitting
*What was the main fault found with the appliance or gas fitting?
*Was an appliance or other type of gas fitting involved?
*What type of appliance or gas fitting was involved?
*What type of gas was involved?
What was the design/construction type of the
Was the appliance bought second hand?
*Summary of the dangerous gas fitting
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About the servicing and installation of the appliance
I know details about
the last service
I do not know any details about
the last service or the installer
Last service details
Who last serviced the appliance?
*On what date was appliance installed?
Name and address of the installer
Please check your email address below. Ensure that you change if incorrect as this is the email address that
your acknowledgement and a copy of the form will be sent to.
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