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Installation fault notice form

Use this form for reporting an installation fault to the owner/occupier and Energy Safety.

If you are a layperson and you believe that your installation or appliance is dangerous, you should immediately turn off the appliance or energy supply and contact a licensed energy worker. More information on living safely with gas and electricity is available on this website.

If you are an energy worker and you believe you have identified an installation where there is an immediate, existing danger (that is, where the actual danger to life or property, if not averted, would result in harm to people or property in the immediate future) then you have a duty to report it.

In such situations, the energy worker should immediately inform the owner or occupier and seek permission to make the scene safe.

They should only then contact Energy Safety. It is important to note that the Energy Safety is not an emergency service.

A good practice guide is available for gasfitters dealing with how they should respond to installation faults they discover.

Note | You must complete the fields that are marked with an asterisk *.


To the user
Owner details (if different)
Date installation fault found
/ /  
This gas/electrical installation... (select one)

Table 1: Immediately dangerous to life or property

any person entitled to carry out gas fitting/prescribed electrical work and who is carrying out gas fitting/prescribed electrical work (or inspecting prescribed electrical work) and who believes on reasonable grounds that a gas/electrical installation, fitting or appliance presents immediate danger to life or property shall, as soon as practicable, advise the owner or occupier of the property where the danger exists, and the Secretary (ES), of that danger.

I must advise you that your appliance or installation is considered to be 'Immediately Dangerous' and if it is used it will create a danger to life or property. It should be turned off and disconnected in the interests of safety.

It is immediately dangerous because:

It should not be used until work has been carried out to correct the deficiencies identified. It is an offence to use an unsafe gas/electrical installation.
With your permission I have (tick as appropriate)

Table 2: Presents a risk to life or property

your gas/electrical appliance or installation does not comply with current regulations, standards and codes and may in the future constitute a danger to life or property. It is recommended that it should not be used until work has been carried out to correct the deficiencies identified. It may be an offence to own, operate or use a gas/electrical appliance or installation knowing it is at risk.

It is at risk because:

Description of gas/electrical installation

Appliance 1

Appliance 2
Notifying gasfitter/electrical worker
Please enter a valid phone number
Please enter a valid email address
Copies sent to/delivered to
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Please note

If you wish to retain a copy of this form, select first the "Generate as PDF" button to save or print a copy.

To send the form to Energy Safety select the “Submit Fault notice“ button. Please note that submitting the form clears all entered data, and you will no longer be able to save a copy.

Last updated 6 June 2014