Title Page
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Site name
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Site/store number
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Location
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Date
DESCRIPTION AND EXTENT OF THE INSTALLATION
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Description of installation:
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New installation
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Addition to an existing installation
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Alteration to an existing installation
System type and earthing arrangements
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TN-C
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TN-S
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TN-C-S
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TT
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IT
Supply Protective Device
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BS (EN)
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Type
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Rated Current (Amps)
Number and type of live conductors
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1-PHASE,2-WIRE
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2-PHASE,3-WIRE
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3-PHASE,3-WIRE
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3-PHASE,4-WIRE
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Confirmation of supply polarity
Nature of Supply Parameters
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Prospective fault current, Ipf (by enquiry or measurement) kA
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External loop impedance, Ze (by enquiry or measurement) Ω
PARTICULARS OF INSTALLATION REFERRED TO IN THE CERTIFICATE
Means of Earthing
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Distributor’s facility
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Installation earth electrode
Maximum Demand (Load) kVA or Amps
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kVA
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Amps
Details of installation Earth Electrode (where applicable)
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Rod(s)
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Tape
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Mat/Grid
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Other (Specify)
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Location
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Electrode resistance to Earth (Ω)
Main Protective Conductors
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Material
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Size (csa) mm2
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Connection / Continuity Verified
Main Protective Bonding Conductors (to extraneous-conductive-parts)
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Material
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Size (csa) mm2
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Connection / Continuity Verified
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To water pipes
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To gas installation pipes
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To oil installation pipes
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To structural steel
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To lightning protection
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To other (Specify)
Main Switch / Switch Fuse / Circuit Breaker /RCD
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Location
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BS (EN)
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Type
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Number of Poles
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Current rating (A)
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Fuse / device rating or setting (A)
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Voltage rating (V)
If RCD Main Switch
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Rated residual operating current (mA)
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Rated time delay (ms)
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Measured operating time (ms)
CIRCUIT DETAILS AT DISTRIBUTION BOARD
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(1) Circuit Number
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(2) Circuit Description
PROTECTIVE DEVICE DETAILS
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(3) Protective Device BS (EN)
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(4) Protective Device Type
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(5) Protective Device Rating (A)
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(6) Protective Device Breaking Capacity (kA)
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(7) RCD Current Rating (mA)
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(8) Maximum Permitted Zs (Ω*) * See note below
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* Where the maximum permitted earth fault loop impedance value stated in (8) is taken from a source other than the tabulated values given in Chapter 41 of this Standard, state the source of the data in the appropriate cell for the circuit in the 'Remarks' cell (25) of the schedule.
CONDUCTOR DETAILS
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(9) Reference Method
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(10) Live (mm2)
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(11) cpc (mm2)
TEST RESULTS
RING FINAL CIRCUIT CONTINUITY (Ω)
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(12) r1 (line)
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(13) rn (neutral)
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(14) r2 (cpc)
CONTINUITY (Ω) (R1 +R2) or R2
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(15) (R1 + R2)
INSULATION RESISTANCE TEST VOLTAGE
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(17) Volts
INSULATION RESISTANCE (MΩ)
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(18) Live - Live
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(19) Live - Earth
POLARITY
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(20) Checked
Zs (Ω)
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(21) Maximum Measured
RCD
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(22) Disconnection Time (ms)
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(23) RCD Test Button Operation
AFDD
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(24) Manual AFDD Test Button Operation
REMARKS
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(25) Remarks
Engineer sign off
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Name & signature
