ELECTRICAL TEST and TAG REPORT

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• This Equipment Belongs To?

OWNER OF APPLIANCE

TYPE OF APPLIANCE and VISUAL INSPECTION.

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TEST RESULTS?

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

• Safe

  At Risk

  N/A

IS THE TECHNICIAN CARRYING A LADDER/S?

• Type of Ladder?

  Yes

  No

  N/A

• Has it Been Inspected and is Safe?

  Safe

  At Risk

  N/A

• Has an Inspection Label Been Fitted.

  Yes

  No

  N/A

SECOND LADDER.

• Type of Ladder?

  Yes

  No

  N/A

• Has it Been Inspected and is Safe?

  Yes

  No

  N/A

• Has an Inspection Label Been Fitted.

  Yes

  No

  N/A

THIRD LADDER.

• Type of Ladder?

  Yes

  No

  N/A

• Has it Been Inspected and is Safe?

  Yes

  No

  N/A

• Has an Inspection Label Been Fitted.

  Yes

  No

  N/A

FOURTH LADDER.

• Type of Ladder?

  Yes

  No

  N/A

• Has it Been Inspected and is Safe?

  Yes

  No

  N/A

• Has an Inspection Label Been Fitted.

  Yes

  No

  N/A

DATE OF NEXT TEST.

• Select date

  Date

TESTERS NAME and LICENCE NUMBER.

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