BPD020202 12/15 W85692

BP ANZ
Gas Test Certificate
BPD020202
 BPD020202 12/15 W85692
BP Australia Pty Ltd
BP Australia Pty Ltd
GAS TEST CERTIFICATE
GAS TEST CERTIFICATE Certificate
Certificate No._______________________
No.

(TO BE ISSUED IN CONJUNCTION WITH A PERMIT)

NOTES:
• This certificate
Gas-Free does does not include
not mean Leadif testing,
Lead-Free, in doubtifcontact
in doubtRegional
contact Engineer.
Regional Engineer.
• This Certificate
Certificate does not authorise any work to be carried out, or entry by a person into a confined
confined space.
Separate
Separate BP
BP Work
Work Permit
Permitor
orConfined
ConfinedSpace
SpaceEntry
EntryPermits
Permitsmust
mustbebeissued
issuedforfor
these purposes.
these purposes.

GAS TESTING: NOTES:

Meter Make/Model: 1. This Certificate is valid on

the day of issue only (unless
Serial No:
re-endorsement has been
Date of Last Equip Calibration: authorised).

Date / Time of last BUMP test: 2. This Certificate shall be held

at the work site (White Copy)
Date / Time of Test:
with Contractor/Employee
Results of Test performing work (Recipient).
Pink Copy to be held by Site
%LEL _____________ % O 2 ______________ H2S _____________ CO
Office and Yellow Copy by
Name of Issuing Authority:
Issuing Authority.
Signature of Issuing Authority:

I hereby certify that:___________________________________ It has been gas tested and found to be suitable for the
following (delete items not applicable):
____________________________________________________

____________________________________________________ a. Hot Work (Permit No ...................................)

____________________________________________________ b. Confined Space

Entry (Permit No ...................................)
____________________________________________________
c. Other (Reference ...................................)
has been gas tested in accordance with the procedures set
out in PRO 4.5-0001-1-01 Permit to Work.

AUTHORISATION TO RE-ENDORSE:
Name of Person Authorised to Re-endorse: ________________________________________________________________
Certificate to be Re-endorsed: ________________________________________________________________
Certificate (Daily/Hourly)
(Daily/Hourly/Other)
Signature
Name of Issuing
of Issuing Officer: ______________________________________________________________________________
Authority: Signature of Issuing Authority:
Date: __________________________________________________________________________________________________
Date:

Part 1 WHITE Contractor Copy

Part 2 PINK Site Office Copy
Part 3 YELLOW Issuing Authority Copy

SEE OVER FOR RE-ENDORSEMENTS

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Re-endorsed by: Date: / / Equipment Make/Model:

Serial No:
Date of Last Equip Calibration:
Name Date/Time of Last BUMP Test:

Date/Time of Test:

Result of Test
Signature
Person Authorised to Re-endorse %LEL %O2 H2S CO

Re-endorsed by: Date: / / Equipment Make/Model:

Serial No:
Date of Last Equip Calibration:
Name Date/Time of Last BUMP Test:

Date/Time of Test:

Result of Test
Signature
Person Authorised to Re-endorse %LEL %O2 H2S CO

Re-endorsed by: Date: / / Equipment Make/Model:

Serial No:
Date of Last Equip Calibration:
Name Date/Time of Last BUMP Test:

Date/Time of Test:

Result of Test
Signature
Person Authorised to Re-endorse %LEL %O2 H2S CO

Re-endorsed by: Date: / / Equipment Make/Model:

Serial No:
Date of Last Equip Calibration:
Name Date/Time of Last BUMP Test:

Date/Time of Test:

Result of Test
Signature
Person Authorised to Re-endorse %LEL %O2 H2S CO

Re-endorsed by: Date: / / Equipment Make/Model:

Serial No:
Date of Last Equip Calibration:
Name Date/Time of Last BUMP Test:

Date/Time of Test:

Result of Test
Signature
Person Authorised to Re-endorse %LEL %O2 H2S CO

Re-endorsed by: Date: / / Equipment Make/Model:

Serial No:
Date of Last Equip Calibration:
Name Date/Time of Last BUMP Test:

Date/Time of Test:

Result of Test
Signature
Person Authorised to Re-endorse %LEL %O2 H2S CO