Information
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This form has been designed to be used by licensed electrical workers to certify low voltage installations or part installations that comply with part 2 of AS/NZS 3000 and are safe to be connected to a 230/400 volt multiple earth neutral (MEN) system of electrical supply.
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Document No.
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Conducted on
Customer Details
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Name
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Address
Location Details
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Name
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Location
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Address
Details of Work
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The work is:
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The prescribed electrical work is:
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Description of Work
Certification of Work
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I certify that the completed prescribed electrical work to which this certificate applies, has been done lawfully and safely and the information in the certificate is correct in that the installation, or part of the installation:
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Has been installed in accordance with a certified design
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Has an earthing system that is correctly rated
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Contains fittings which are safe to connect to the power supply
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Relies on suppliers declaration of conformity
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Relies on manufacturers instructions
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Has been satisfactorily tested in accordance with the electricity (safety) regulations 2010
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Is safe to connect
