Information
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Site Name :
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Site No. (If applicable) :
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Date:
Part 1 - Details of the Minor Works
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Please Note - To be used only for minor electrical work - not including the provision of a new circuit.
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Client:
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Date minor works completed:
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Contract Reference (if any):
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Description of the Minor Works:
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Details of Departures from BS7671 if any:
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Location/Address of the Minor Works:
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Address 1:
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Address 2:
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Address 3:
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Address 4:
Part 2 - Details Of The Modified Circuit
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System Type and Earthing Arrangements:
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Protective Measure(s) against Elec. Shock:
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Overcurrent protective device for the modified circuit:
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1) BS(EN):
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2) Type:
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3) Rating (Amps):
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Residual current device (if applicable):
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a) BS(EN):
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b) Type:
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c) I Δ n (mm2):
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Details of wiring system used to modify the circuit:
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Type of wiring system used:
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Reference Method:
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csa of lives (mm2):
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csa of cpc (mm2):
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Where the measure for protection against electric shock is ADS, insert MAXIMUM disconnection time permitted by BS7671:
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Time in Seconds:
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MAXIMUM Zs permitted by BS7671 (Ω):
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Comments (if any) on the existing installation, including adequacy of earthing and bonding arrangements (see regulation 132.16):
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Comments:
Part 3 - Inspection and Testing of the Modified Circuit and Related Parts
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Please give confirmation that necessary inspections have been undertaken.
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Confirmation:
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Circuit Resistance:
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R1 + R2 (Ω):
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OR R2 only (Ω):
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Insulation Resistance
( * In a multi-phase circuit record the lower! or lowest value as appropriate). -
Line / Line * (MΩ):
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Line / Neutral * (MΩ):
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Line / Earth * (MΩ):
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Neutral / Earth * (MΩ):
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Confirm adequacy of earthing:
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Confirm adequacy of protective bonding:
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Confirm correct polarity:
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Max earth fault loop impedance, Zs:
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RCD operating time at I Δ n (if RCD fitted):
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RCD operating time at 5 I Δ n (if applic.):
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Agreed limitations, if any, on the inspection and testing.
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Limitations:
Part 4 - Declaration
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I / We certify that the minor electrical installation works, as detailed in Part 1 of this certificate, does not impair the safety of the existing installation, that the said works have been designed, constructed, inspected, tested and verified in accordance with BS 7671, amended on the date shown*, and that, to the best of my/our knowledge and belief, at the time of my/our inspection,the works complied with BS 7671 except as detailed in part 1 of this certificate.
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Eng. Name (CAPITALS):
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Position:
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Date:
