Electrical Installation Condition Report

• Electrical Installation Certificate No.

• Client

• Location
  Address

• Conducted on

  Date

• Prepared by

• Purpose for which this report is required

  Visual Inspection

  Periodic Inspection

• Date of last inspection and testing carried out

  Date

• Previous periodic inspection or condition report no.

Details of Installation

• Are the installation records available?

  Yes

  No

  N/A

• Description of premises

  Domestic

  Commercial

  Industrial

  Other

• Estimated age of the electrical installation

Extent of the Installation and Limitations of the Inspection and testing

• Extent of the electrical installation covered by this report

• Agreed limitations (including the reasons), if any, on the inspection and testing

• Operational limitations including the reasons

Summary of the condition of the installation

• General condition of the installation (in terms of electrical safety)

• Overall assessment of the installation

  Safe

  At Risk

  N/A

Documentation

• Click + to add media information for documentation

Photo

• Take a photo of any significant information (e.g. faulty wires, damaged equipment, etc)

  Media

• Description

Completion

• Reviewed and confirmed by (Full Name and Signature of Qualified Supervisor of the Approved Contractor)

  Sign