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["附件3"]
["瓶装液化气非居民用户燃气设施安全检查表"]
["用户名称","","用户联系人签字",""]
["用户地址","","用户电话",""]
["供气企业 ","名称：                                      协议：有口；无口  ","检查时间","年         月        日"]
["用气设备","口燃气灶具（家用灶、中餐炒灶、大锅灶）；口蒸箱；口热水器；口锅炉；口热水炉；口其他："]
["检查单元","检查项目","检查情况","不符合处置措施"]
["安全管理","有燃气安全使用信息公示牌","符合口              不符合口","在醒目处设置公示牌"]
[null,"有安全管理制度或操作规程且在明显处张贴","符合口             不符合口","立即制定制度或操作规程"]
[null,"人员经过专业培训，熟悉安全用气操作","符合口                 不符合口","立即请燃气公司对用气人员进行培训"]
[null,"有应急处置方案，且每半年进行1 次应急处置演练（九小场所不查）","符合口              不符合口","立即制定应急处置方案并组织演练"]
[null,"与供气企业签订供用气合同","符合口            不符合口","立即补签合同"]
[null,"进行过安全用气自检，有自检单，每月不少于1次","符合口            不符合口","按要求整改"]
[null,"供气企业入户安全检查每年不小于1次（提供供气企业检查表）（九小场所不查）","符合口              不符合口","通知供气企业立即安排上门安检"]
["泄漏 检查","钢瓶角阀、调压器、连接管连接紧密，无泄漏现象","符合口             不符合口","立即停止用气，切断气源，维修或更换"]
[null,"使用专用卡箍，连接紧固，软管未脱落，无泄漏现象","符合口               不符合口"]
["钢瓶存放 及用气场 所检查","钢瓶在检验有效期内","符合口             不符合口","立即停用，退回供气企业"]
[null,"扫描钢瓶二维码显示的充装、配送信息应与实际相符","符合口               不符合口","立即停用，退回供气企业"]
[null,"钢瓶未摆放在密闭橱柜中","符合口                   不符合口","按要求整改，应保持通风良好"]
[null,"超量存放钢瓶（超100公斤须设独立气瓶间）","符合□              不符合口","减少钢瓶数量或设置专用储瓶间"]
[null,"未使用油、酒精、生物质燃料、煤、柴等其他燃料","符合口                    不符合口","立即停止用气，切断气源，按要求整改"]
[null,"钢瓶存放和用气房间为专用，未做居住、洗浴等其他功能使用","符合口                  不符合口","立即停止用气，切断气源，按要求整改"]
[null," 安装有燃气泄漏报警器，间距小于4米，距地面小于30cm","符合口               不符合口","按要求整改"]
[null,"报警器检定(校验）有效期1年","符合口              不符合口","立即停用，安排校验检定或更换"]
[null,"从气瓶间通过硬管连接到灶具等的，安装有燃气泄漏安全保护装置（切断阀采用硬管连接)","符合口                   不符合口","请供气企业指导重新安装"]
["调压器","调压器为商用非可调式螺纹接口，未使用可调压式中、高压调压器（调压阀不得有手动旋转开关）","符合口                不符合口","更换"]
[null,"明显标识安装使用时间，且未超过8年","符合口\n不符合口 ","更换"]
["连接软管"," 采用燃气专用金属包覆软管或不锈钢软管","符合口\n不符合口 ","立即更换"]
[null,"软管无变硬、发黏等老化迹象，无龟裂、破损、磨损等现象，金属软管无明显锈蚀、破损、磨损等现象","符合口\n不符合口","立即更换"]
[null," 明显标识安装使用时间，且未超过产品设计使用年限","符合口\n不符合口","更换"]
[null,"软管长度不超过2.0m","符合口\n不符合口","更换软管或减少距离"]
[null,"软管中间无接口，无三通分流","符合口\n不符合口 ","严禁使用"]
[null,"软管无穿越墙、橱柜、暗埋等现象","符合口\n不符合口 ","请供气企业指导重新安装"]
["燃烧器具","明显标识安装使用时间，且未超过高产品设计使用年限","符合口\n不符合口 ","更换"]
[null,"未使用猛火灶","符合口\n不符合口 ","立即停止用气，切断气源，更换"]
[null,"使用螺纹接口的金属软管和专用阀门连接","符合口\n不符合口 ","立即停止用气，切断气源，建议更换"]
[null,"有熄火保护装置，且工作正常","符合口\n不符合口 ","立即停止用气，切断气源，请厂家维修"]
[null,"燃绕正常，无黑烟、红火，无泄漏，烟道安装紧密、完 好、畅通、规范、通出室外","符合口\n不符合口 ","立即停止用气，切断气源，按要求整改"]
[null,"燃气燃烧器具在关闭状态下，无泄漏规象","符合口\n不符合口 ","立即停止用气，切断气源，请厂家维修"]
["其他 安全 隐患",""]
["备注说明","本表格，是根据市里编制的非居民用户自查表进行调整的，各行业主管部门和街道是对用户的自查情况进行复核。"]
["检查单位：                                                                                   检查人员："]