Example Certificate Of Compliance

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Electrical
TESTING AND COMPLIANCE
(
)
installations
CERTIFICATE OF:
Issued in accordance with s227 of the Electrical Safety Regulation 2013
Electrical
TESTING AND SAFETY
(
)
(Please mark relevant check-box)
equipment
Issued in accordance with s26 of the Electrical Safety Regulation 2013
*
Work performed for:
*
Name
Title
Given name/s
Surname
*
Address
Street
Suburb/town
Postcode
*
Electrical installation / equipment tested
( please include site address for electrical installation work if different from above ):
*
*
Date of test
/
/
Electrical contractor licence number
Name on contractor licence
Electrical contractor phone number
For electrical installations, this certifies that the electrical installation, to the extent it is
affected by the electrical work, has been tested to ensure that it is electrically safe and is in
accordance with the requirements of the wiring rules and any other standard applying under
the Electrical Safety Regulation 2013 to the electrical installation.
For electrical equipment, this certifies that the electrical equipment, to the extent it is affected
.
by the electrical work, is electrically safe
Name
Person who performed, or person who is responsible for, the electrical work
/
/
Signature
Date
*
Indicates a mandatory field
V4.12-2013

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