If this case relates to an escape of a flammable gas that meets the criteria of Schedule 2 Part 1 Section 19, then please use the Dangerous Occurrence form (Report a Dangerous Occurrence NI2508). If this case relates to a flammable gas incident causing death or a major injury then please contact HSENI directly on 0800 0320 121 to report it.
About you and your organisation
When was the dangerous gas fitting found?
What is the address and postcode at which it was found?
If Yes selected, enter the details of the landlord/managing agents.
Was the landlord (or the managing agent for the premises) notified about the faults:
Did Incident happen in a building?:*
Was the fault repaired at the time?
If not was the situation made safe by disconnection or contact with the providers emergency centre for them to disconnect.
Disconnected:*
What was the name of the person living in the premises? (If they cannot be contacted, give the name, address and telephone number of a relative or friend)
About the dangerous gas fitting
What type of appliance was Involved?
What type of gas was Involved?
Was the appliance bought second hand (if known)?
Summary of the dangerous gas fitting
Please say how dangerous you consider it to be, and why/what action you have taken to make things safe eg. Repairing, disconnection gas supply, advising occupiers (or landlords/managing agents) or reporting to the gas provider.
About the servicing and Installation of the appliance/gas fitting
Do you know who last serviced the appliance?
Service:
Do you know who Installed the appliances/gas fitting?
Installation:
If submitting this on line, 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.