3142

• Location
  Address

• Conducted on

  Date

• Name of person conducting the inspection:

• Company conducting the inspection:

• Registration type and number:

• Certificate of Periodic Verification

• This certificate covers the following:
  Visual inspection and limited testing in accordance with AS/NZS 3019:2007.

• Estimated age of installation:

• Evidence of alterations or additions since last inspection:

  Yes

  No

• Estimate when carried out:

• Date of last inspection (if known):

Switchboard

• Is the Switchboard compliant?

  Yes

  No

  N/A

• What is the Main Switch kVa rating?

• Is the Switchboard labelled correctly?

  Yes

  No

  N/A

Inspection of Mains Cables

• Location of Mains Cables

  Overhead

  Underground

• Are the Main Cables Compliant?

  Yes

  No

  N/A

Testing

• RCD test

  Compliant

  Non-Compliant

  N/A

• Push button test

  Compliant

  Non-Compliant

  N/A

• Insulation resistance: (M Ohms)

  Compliant

  Non-Compliant

  N/A

Additional Inspections

• Have all accessible switches been checked?

  Yes

  No

  N/A

• Why have all accessible switches not been checked?

• Are all accessible switches compliant?

  Yes

  No

  N/A

• If there are any non-compliant switches, have any works been completed to have these items rectified?

  Yes

  No

  N/A

• Have all accessible powerpoints been checked

  Yes

  No

  N/A

• Why have all accessible power points not been checked?

• Are all accessible powerpoints compliant

  Yes

  No

  N/A

• If there are any non-compliant powerpoints, have any works been completed to have these items rectified?

  Yes

  No

  N/A

• Any other observations?

  Yes

  No

• Detail these observations

Limitations of inspection:

• Are there any limitations to this inspection?

  Yes

  No

Overall Inspection Result:

• WHAT IS THE OVERALL COMPLIANCE STATUS OF THIS PROPERTY?

  COMPLIANT

  NON-COMPLIANT

  N/A
Smoke Alarm Check

• Is there a Smoke Alarm Check?

  Yes

  No

• Unit location

• Unit brand?

• Unit expiration date

• Hard wired or battery powered?

  Hardwired

  Battery

• Test battery. Required replacement?

  Yes

  No

• Interconnecting units?

  Yes

  No

• • Unit placed within 400mm of an air-conditioning vent?<br>• Unit placed within 300mm of a corner of a ceiling or wall?

  Pass

  Pass - required rectification

  Failed - unable to rectify

• General condition of unit:

  Pass

  Pass - required rectification

  Failed - unable to rectify

• Unit required in location?

  Yes

  No

• Have the following tests been completed?<br>- Push button test<br>- Smoke simulation test<br>- Decible test

  Yes - compliant

  Yes - non-compliant

  No

• Detail non-compliance:

• Reason for not completing test(s)

• Cleaned detector and surrounding areas?

  Yes

  No

• Overall Smoke Alarm unit result?

  Select Compliant Compliant - Unit Replaced Compliant - Unit Relocated Compliant - New Installation Non-Compliant - Requires Replacement Non-Compliant - Requires Relocation Non-Compliant - Requires New Installation Compliant - Recommended Works

  • Compliant
  • Compliant - Unit Replaced
  • Compliant - Unit Relocated
  • Compliant - New Installation
  • Non-Compliant - Requires Replacement
  • Non-Compliant - Requires Relocation
  • Non-Compliant - Requires New Installation
  • Compliant - Recommended Works

Electrical Maintenance Check

• Is there an Electrical Maintenance Check?

  Yes

  No

• Inspect and ensure all light fittings are in working order.

  Completed - No works required

  Completed - Works required

• Check that all sweep fans and exhaust fans are working<br>correctly, checking to make sure no bearings have started<br>to seize up and nothing is catching on the blade.

  Completed - No works required

  Completed - Works required

• Test oven temperatures, make sure ovens are heating up<br>to the correct operating temperature.

  Completed - No works required

  Completed - Works required

Certification

• Having carried out a verification of the above installation in accordance with the requirements of AS/NZS 3019:2007 I hereby certify that, subject to the type of verification and limitations as detailed above, the installation satisfies the requirements of AS/NZS 3019:2007 for the issue of this Certificate.

• Signature:

  Sign

• This report is a valuable document on the safety status of the electrical installation and should be retained for future reference. Placing in or near the main electrical switchboard is recommended. For safety reasons, the electrical installation should be re-inspected at the recommended period by a competent person and this copy given to the person carrying out the next verification. This report is valid for 2 years from the date of inspection.