Where do the customer and technician sign on Kansas Form 821?
Where do the customer and technician sign on Kansas Form 821?
Kansas’s published interruption-of-service form has separate dated signature lines for the customer and the dealer representative. It also separates the system leak-check results from the pressure-check results.
Read the whole form before building a shorter one
The State Fire Marshal’s Form 821, revised March 4, 2026, asks for the dealer, customer and physical location. It includes tank and regulator information, appliances, a visual check, and separate spaces for test pressure and time held.
The customer acknowledgment and dealer certification describe what each person is signing. Treat those statements as part of the form rather than cutting them down to an unexplained signature box. The form also limits the inspection to visible, accessible equipment and conditions at the inspection date.
Before using a different form, have your safety lead confirm the current Kansas rule and whether approval is needed. Have that person check which service events require the form, including the regulator work at hand.
FAQ
Can one signature stand in for both people?
Form 821 provides two distinct signature lines. Keep each signature connected to its own statement and date.
Is this a permanent guarantee of the system?
No. Read the inspection limitations printed on the state form.
Primary source: Kansas State Fire Marshal Form 821, revision 03/04/2026.
Review Tank Spotter against the state form, including both acknowledgments and the separate test sections.
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