INFORMATION
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Housing Authority's Works Order Number
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Location
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Conducted on
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Document No.
REMEDIATION
ELECTRICAL SAFETY DEVICE REMEDIATION
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(R.1) Confirm if the remediation was either for a Safety Switch, Smoke Alarm or Main Earth.
- MAIN EARTH
- SAFETY SWITCH
- SMOKE ALARM
MAIN EARTH REPAIR
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(R.M.1) Confirm what remediation work was performed on the Main Earth.
- Replace Main Earth - Complete
- Replace Main Earth Electrode
- Replace Main Earth Wire
- Renew Equipotential Bond
- Renew Tag on Electrode
- OTHER
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(R.M.1.O) Provide further details of remediation performed on the Main Earth.
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(R.M.T.1) Confirm that a Continuity Check has been performed from the earth electrode to the property switchboard.
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(R.M.T.2) Confirm that the Earth Resistance is below 0.5Ω.
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(R.M.T.3) Confirm that the MEN connection is compliant.
SAFETY SWITCH REPAIR
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Add Safety Switch Details
Safety Switch
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(R.S.1) Confirm if the safety switch is a new inclusion or a replacement.
OLD SAFETY SWITCH
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(R.S.1.P) Take a clear, centred and legible photograph of the old safety switch (NOT THE WHOLE SWITCHBOARD.)
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(R.S.1.R) Confirm the sub-circuit protected by the OLD safety switch, that is if it is Power, Light or Other.
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(R.S.1.R.O) Confirm the number ID of the safety switch.
- O1
- O2
- O3
- O4
- O5
- O6
- O7
- O8
- O9
- O10
- O11
- O12
- O13
- O14
- O15
- OTHER
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(R.S.1.R.O.1) Identify safety switch.
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(R.S.1.R.L) Confirm the number ID of the safety switch.
- L1
- L2
- L3
- L4
- L5
- L6
- L7
- L8
- L9
- L10
- OTHER
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(R.S.1.R.L.1) Identify safety switch.
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(R.S.1.R.P) Confirm the number ID of the safety switch.
- P1
- P2
- P3
- P4
- P5
- P6
- P7
- P8
- P9
- P10
- P11
- P12
- P13
- P14
- P15
- OTHER
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(R.S.1.R.P.1) Identify safety switch.
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(R.S.1.R.M) Confirm the Make of the OLD safety switch.
- ABB
- CLIPSAL
- DIELLE
- EATON
- HAGER
- HEINELEC
- HEINEMAN
- HPM
- LANSON
- LEGRAND
- MACK
- MOELLER
- NHP
- QCE
- QUICKLAG
- SCHNEIDER
- OTHER
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(R.S.1.R.M.O) Confirm the Make of the OLD safety switch.
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(R.S.1.R.T) Confirm the Type of the OLD safety switch.
NEW SAFETY SWITCH
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(R.S.1.R.N.M) Confirm the Make of the safety switch.
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(R.S.1.R.N.C.C) Confirm the Model of the Clipsal safety switch.
- RCD240/30
- RCBM210/30
- RCBM216/30
- RCBM220/30
- RCBM225/30
- RCBM232/30
- 4RCBE210/30S40
- 4RCBE216/30S40
- 4RCBE220/30S40
- 4RCBE225/30S40
- 4RCBE232/30S40
- OTHER
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(R.S.1.R.N.C.C.1) Record the Model of the Clipsal safety switch.
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(R.S.1.R.N.C.I) Confirm the Make of the Industrial safety switch.
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(R.S.1.R.N.C.I.M) Confirm the Model of the Industrial safety switch.
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(R.S.1.R.N.C.A) Confirm the Model of the ABB safety switch.
- FH202 AC-40/0,03
- DS201BS C10 AC30
- DS201BS C16 AC30
- DS201BS C20 AC30
- DS201BS C25 AC30
- DS201BS C32 AC30
- DSN201 C10 AC30
- DSN201 C16 AC30
- DSN201 C20 AC30
- DSN201 C25 AC30
- OTHER
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(R.S.1.R.N.C.A.1) Record the Model of the ABB safety switch.
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(R.S.1.R.N.C.L) Confirm the Model of the legrand safety switch.
- TX3 4115 10
- 4110 00
- 4110 02
- 4110 03
- 4110 04
- 4110 05
- 4111 29
- 4111 31
- 4111 32
- 4111 33
- 4111 34
- OTHER
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(R.S.1.R.N.C.L.1) Record the Model of the legrand safety switch.
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(R.S.1.R.N.C.N) Confirm the Model of the NHP safety switch.
- MOD6-RCCB-2-40-30
- M6RCB-D-10-30-CAN
- M6RCB-D-16-30-CAN
- M6RCB-D-20-30-CAN
- M6RCB-D-25-30-CAN
- M6RCB-D-32-30-CAN
- OTHER
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(R.S.1.R.N.C.N.1) Record the Model of the NHP safety switch.
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(R.S.1.R.N.T) Confirm the Type of safety switch.
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(R.S.1.R.N.K) Confirm that the safety switch has a minimum kiloamperes rating of 6kA.
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(R.S.1.R.N.M) Confirm that the safety switch is has a Milliamperes rating of 30mA.
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(R.S.1.R.N.P.S) Take a clear, centred and legible photograph of serial/batch number. NOTE: This serial/batch number is found on either the front of the box of the new Safety Switch, or on the side of the new Safety Switch
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(R.S.1.R.N.S) Confirm the serial number of the safety switch.
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(R.S.1.R.N.1) Confirm that the safety switch has passed the Integrated Push Button Test.
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(R.S.1.R.N.2) Using the Metrel 3017 confirm that the safety switch has passed the Trip Time Test.<br><br>Max Permitted: 40m/s
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(R.S.1.R.N.P.I) Take a clear, centred and legible close-up (NOT THE WHOLE SWITCHBOARD) photograph of the front of the installed safety switch.
NEW SAFETY SWITCH
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(R.S.1.N) Confirm the sub-circuit protected by the new safety switch, that is if it is Power, Light or Other.
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(R.S.1.N.O) Confirm the number ID of the safety switch.
- O1
- O2
- O3
- O4
- O5
- O6
- O7
- O8
- O9
- O10
- O11
- O12
- O13
- O14
- O15
- OTHER
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(R.S.1.N.O.1) Identify safety switch.
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(R.S.1.N.L) Confirm the number ID of the safety switch.
- L1
- L2
- L3
- L4
- L5
- L6
- L7
- L8
- L9
- L10
- OTHER
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(R.S.1.N.L.1) Identify safety switch.
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(R.S.1.N.P) Confirm the number ID of the safety switch.
- P1
- P2
- P3
- P4
- P5
- P6
- P7
- P8
- P9
- P10
- P11
- P12
- P13
- P14
- P15
- OTHER
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(R.S.1.N.P.1) Identify safety switch.
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(R.S.1.N.M) Confirm the Make of the safety switch.
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(R.S.1.N.C.I) Confirm the Make of the Industrial safety switch.
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(R.S.1.N.C.I.M) Confirm the Model of the Industrial safety switch.
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(R.S.1.N.C.A) Confirm the Model of the ABB safety switch.
- FH202 AC-40/0,03
- DS201BS C10 AC30
- DS201BS C16 AC30
- DS201BS C20 AC30
- DS201BS C25 AC30
- DS201BS C32 AC30
- DSN201 C10 AC30
- DSN201 C16 AC30
- DSN201 C20 AC30
- DSN201 C25 AC30
- OTHER
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(R.S.1.N.C.A.1) Record the Model of the ABB safety switch.
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(R.S.1.N.C.C) Confirm the Model of the Clipsal safety switch.
- RCD240/30
- RCBM210/30
- RCBM216/30
- RCBM220/30
- RCBM225/30
- RCBM232/30
- 4RCBE210/30S40
- 4RCBE216/30S40
- 4RCBE220/30S40
- 4RCBE225/30S40
- 4RCBE232/30S40
- OTHER
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(R.S.1.N.C.C.1) Record the Model of the Clipsal safety switch.
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(R.S.1.N.C.L) Confirm the Model of the legrand safety switch.
- TX3 4115 10
- 4110 00
- 4110 02
- 4110 03
- 4110 04
- 4110 05
- 4111 29
- 4111 31
- 4111 32
- 4111 33
- 4111 34
- OTHER
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(R.S.1.N.C.L.1) Record the Model of the legrand safety switch.
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(R.S.1.N.C.N) Confirm the Model of the NHP safety switch.
- MOD6-RCCB-2-40-30
- M6RCB-D-10-30-CAN
- M6RCB-D-16-30-CAN
- M6RCB-D-20-30-CAN
- M6RCB-D-25-30-CAN
- M6RCB-D-32-30-CAN
- OTHER
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(R.S.1.N.C.N.1) Record the Model of the legrand safety switch.
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(R.S.1.N.T) Confirm the Type of safety switch.
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(R.S.1.N.K) Confirm that the safety switch has a minimum kiloamperes rating of 6kA.
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(R.S.1.N.M) Confirm that the safety switch is has a milliamperes rating of 30mA.
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(R.S.1.N.P.S) Take a clear, centred and legible photograph of serial/batch number. NOTE: This serial/batch number is found on either the front of the box of the new Safety Switch, or on the side of the new Safety Switch
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(R.S.1.N.S) Confirm the serial number of the safety switch.
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(R.S.1.N.1) Confirm that the safety switch has passed the Integrated Push Button Test.
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(R.S.1.N.2) Using the Metrel 3017, confirm that the safety switch has passed the Trip Time Test.<br><br>Max Permitted: 40m/s
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(R.S.1.N.P.I) Take a clear, centred and legible close-up (NOT THE WHOLE SWITCHBOARD) photograph of the front of the installed safety switch.
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(R.S.1.S) Take clear, centred and legible photographs of the switchboard with the new safety switch(es) installed. 1. With the cover off so that the wires are visible. 2. With the cover on but screen up so that the writing is legible.
SMOKE ALARM REPAIR
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Add Smoke Alarm Details
Smoke Alarm
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(R.A.1) Confirm if the Smoke Alarm remediation was for a new install, a replacement or relocation.
RELOCATE SMOKE ALARM
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(R.A.3.R) Confirm that the smoke alarm has been relocated to the new compliant location.
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(R.A.3.L) Confirm Location of the Smoke Alarm.
- Bedroom
- Community Room
- Dining
- Entry
- Family
- Games Room
- Kitchen / Dining
- Laundry
- Lounge
- Lounge / Kitchen
- Passage
- Sleepout
- Stairwell
- Study / Office
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(R.A.3.L.P) Confirm that the Smoke Alarm has been labelled with the following identifier.<br><br>NOTE: This needs to be written onto the front of the device.<br>
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(R.A.3.L.B) Confirm that the Smoke Alarm has been labelled with the following identifier. NOTE: This needs to be written onto the front of the device.
- B1
- B2
- B3
- B4
- B5
- B6
- B7
- B8
- B9
- B10
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(R.A.2.M) Confirm the Make of the Smoke Alarm.
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(R.A.2.M.P) Confirm the model.
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(R.A.2.M.B) Confirm the model.
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(R.A.2.E) Confirm the Smoke Alarm expiry date. NOTE: Expiry date for PSA Smoke Alarms is either: 1. The "REPLACE BY" date found on the side of the device in format: 01/MM/YY, or if not available; 2. The manufacture date found on the back of the device plus 10 years, in format DD/MM/YY. Expiry date for Brooks Smoke Alarms is the "Replace By" date found on the side of the device.
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(R.A.3.E.C) Confirm the expiry date has been written onto the front of the smoke alarm in the format MM-YY.
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(R.A.3.P) Take a clear, centred and legible photographs of the Smoke Alarm. NOTE: Photographs required: 1. BACK - Writing on the back of the device. 2. FRONT - Showing the labelled Passage or Bedroom ID (ONLY IF REQUIRED) and expiry date in the format MM-YY. 3. SIDE - "Replace By" date on the side (ONLY IF PRESENT).
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(R.A.3.T) Confirm that with the circuit de-energised that the Smoke Alarm has passed the Integrated Push Button Test and sounded.
OLD SMOKE ALARM DETAILS
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(R.A.1.P) Take a clear, centred and legible photograph of the OLD Smoke Alarm. NOTE: Photographs required: 1. BACK - Writing on the back of the device. 2. FRONT - Showing the labelled Passage or Bedroom ID (ONLY IF REQUIRED) and expiry date in the format MM-YY. 3. SIDE - "Replace By" date on the side (ONLY IF PRESENT). If the Smoke Alarm is missing, damaged or dirty capture a image that demonstrates this.
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(R.A.1.M) Confirm the Make of the OLD Smoke Alarm.
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(R.A.1.M.O) Confirm the Make and Model of the smoke alarm.
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(R.A.1.M.P) Confirm the model.
- 4800RL
- 5800RL
- 5800RL-2
- PE10
- 10YPEW
- OTHER
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(R.A.1.M.P.1) Confirm the Model of the smoke alarm.
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(R.A.1.M.B) Confirm the model.
- EIB166e
- EIB3016
- EIB650iC
- EIPFSPTLH
- EIB605TYC
- PFS-PTL
- PFS-ITL
- OTHER
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(R.A.1.M.B.1) Confirm the Model of the smoke alarm.
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(R.A.1.E) Does the smoke alarm have an expiry date or manufacture date on the device?
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(R.A.1.E.D) Confirm the Smoke Alarm expiry date. NOTE: Expiry date for Smoke Alarms is either: 1. The "REPLACE BY" date found on the side of the device in format: 01/MM/YY, or if not available; 2. The manufacture date found on the back of the device plus 10 years, in format DD/MM/YY.
NEW SMOKE ALARM
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(R.A.2.L) Confirm Location of the new Smoke Alarm.
- Bedroom
- Community Room
- Dining
- Entry
- Family
- Games Room
- Kitchen / Dining
- Laundry
- Lounge
- Lounge / Kitchen
- Passage
- Sleepout
- Stairwell
- Study / Office
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(R.A.2.L.P) Confirm that the new Smoke Alarm has been labelled with the following identifier.<br><br>NOTE: This needs to be written onto the front of the device.<br>
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(R.A.2.L.B) Confirm that the new Smoke Alarm has been labelled with the following identifier. NOTE: This needs to be written onto the front of the device.
- B1
- B2
- B3
- B4
- B5
- B6
- B7
- B8
- B9
- B10
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(R.A.2.M) Confirm the Make of the new Smoke Alarm.
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(R.A.2.M.P) Confirm the model.
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(R.A.2.M.L) Confirm the model.
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(R.A.2.E) Confirm the new Smoke Alarm expiry date. NOTE: Expiry date for the Smoke Alarms is the "REPLACE BY" date found on the side of the device in format: 01/MM/YY
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(R.A.2.E.C) Confirm the expiry date has been written onto the front of the smoke alarm in the format MM-YY, e.g. 01-27.
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(R.A.2.P) Take a clear, centred and legible photographs of the NEW Smoke Alarm. NOTE: Photographs required: 1. BACK - Writing on the back of the device. 2. FRONT - Showing the labelled Passage or Bedroom ID (ONLY IF REQUIRED) and expiry date in the format MM-YY. 3. SIDE - "Replace By" date on the side.
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(R.A.2.T) Confirm that, with the circuit de-energised, the new Smoke Alarm has passed the Integrated Push Button Test and sounded.
LIMITATIONS
LIMITATIONS
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A limitation to service is anything that inhibits your ability to perform your duty as an electrician with regard to this report.
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Add Limitation
Limitation
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(L.1) Location of the limitation.
- Bedroom
- Community Room
- Dining
- Entry
- Family
- Games Room
- Kitchen / Dining
- Laundry
- Lounge
- Lounge / Kitchen
- Passage
- Sleepout
- Stairwell
- Study / Office
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(L.2) Device - the subject of the limitation.
- Main Earth
- Power Outlet
- Safety Switch
- Smoke Alarm
- Switchboard
- OTHER
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(L.2.1) Provide detail of the device.
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(L.3) Issue - the cause of the limitation.
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(L.3.1) Provide further detail of the issue.
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If a limitation to service is significant enough so as to be deemed dangerous, contact your principal immediately to advise them of the limitation.
COMPLIANCE
Final Checks & Sign Off
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(C.N) Additional comments and notes.
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(C.C) I certify that, subject to the limitations noted, the electrical installing work that is the subject of this certificate has been completed, checked and tested and, at the time of testing, met the compliance requirements of the Housing Authority, Building Code & Electricity (Licensing) regulations 1991 and is safe.
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(C.C.C) Electrical Contractor Number.
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(C.C.W) Electrical Worker Number.
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(C.C.N) Name & Signature.
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THIS COMPLIANCE CERTIFICATE NEEDS TO BE EMAILED TO THE PRINCIPAL BEFORE YOU EXIT.
