Title Page

  • Date of Issue

  • Client Name

  • Location
  • Reference/Certificate ID No.

Certificate of Compliance

Electrical Worker's Details

  • Name of Electrical Worker

  • Registration/Practising License Number

  • Phone/Email

Owner/Occupier's Details

  • Owner/Occupier's Name

  • Installation Address
  • Start Date of Electrical Work

  • Finish Date of Electrical Work

Details of Work Completed

  • General Description of Work

  • The following detailed information must also be provided - indicate the number or rating in each category

  • Lights

  • Socket outlets

  • Cooking appliances

  • Water heaters

  • Motors

  • Air conditioners

  • RCDs

  • Smoke Alarms

Details of RCD Protection

  • Are all the socket outlet and lighting final subcircuits of the installation are protected by at least two RCDs?

  • If NO, what circuits are not protected?

Details of any defects observed (alterations and additions only)

Electrical Safety Certificate

  • By signing this document I certify that the electrical installing work that is subject of this certificate has been completed, checked and tested , and at the time of testing, met the requirements of the regulations and is safe.

  • Certifier's Name

  • Registration/Practicing License Number

  • Certification Issue Date

  • Connection Date

  • Certifier's Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.