Information
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Document No.
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Title
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Prepared for:
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Trading title:
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Trading Address:
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NICEIC Enrolment No
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Phone Number:
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Name:
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Position:
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Date & Time:
DETAILS OF THE DANGEROUS CONDITION
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DETAILS OF THE DANGEROUS CONDITION
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While at the premises/location indicated below, an electrical condition has been observed which, in the opinion of the competent person issuing this Notification, constitutes a real and immediate danger to persons, property or livestock. THE PERSON(S) HAVING RESPONSIBILITY FOR THE SAFETY OF THE ELECTRICAL INSTALLATION OR EQUIPMENT CONCERNED HAVE A DUTY TO ENSURE THAT APPROPRIATE ACTION IS TAKEN WITHOUT DELAY TO REMOVE DANGER. General information and advice is given in section 8. The competent person issuing this Notification will be able to provide further specific advice.
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Dangerous condition :
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The dangerous condition detailed above may result in risk of injury or loss from
- Burns from hot surfaces
- Burns from the passage of electric current
- Electric shock
- Explosion
- Fire
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ORGANIZATION AND/OR PERSON RESPONSIBLE
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Organization and/or person responsible:
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Address :
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Email :
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ADDRESS AND SPECIFIC LOCATION OF DANGEROUS CONDITION
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Address :
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Location:
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Location details :
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IMMEDIATE ACTION TAKEN
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Details :
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FURTHER URGENT ACTION RECOMMENDED
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Details :
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RECEIPT
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Add signature
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Name :
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Position :
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Select date
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Note :
