ELECTRICAL TEST and TAG REPORT

• Test And Tag

• Document No.

• Conducted on

  Date

• Prepared by

• Personnel

OWNER OF APPLIANCE

• Brand of Equipment.

• Type of Equipment.

• Plant Number.

• Visual Inspection.

  Safe

  At Risk

  N/A

• Electrical Test.

  Safe

  At Risk

  N/A

• Photo of Appliance.

  Media

• Brand of Equipment.

• Type of Equipment.

• Plant Number.

• Visual Inspection.

  Safe

  At Risk

  N/A

• Electrical Test.

  Safe

  At Risk

  N/A

• Photo of Appliance.

  Media

• Brand of Equipment.

• Type of Equipment.

• Plant Number.

• Visual Inspection.

  Safe

  At Risk

  N/A

• Electrical Test.

  Safe

  At Risk

  N/A

• Photo of Appliance.

  Media

• Brand of Equipment.

• Type of Equipment.

• Plant Number.

• Visual Inspection.

  Safe

  At Risk

  N/A

• Electrical Test.

  Safe

  At Risk

  N/A

• Photo of Appliance.

  Media

• Brand of Equipment.

• Type of Equipment.

• Plant Number.

• Visual Inspection.

  Safe

  At Risk

  N/A

• Electrical Test.

  Safe

  At Risk

  N/A

• Photo of Appliance.

  Media

• Brand of Equipment.

• Type of Equipment.

• Plant Number.

• Visual Inspection.

  Safe

  At Risk

  N/A

• Electrical Test.

  Safe

  At Risk

  N/A

• Photo of Appliance.

  Media

• Brand of Equipment.

• Type of Equipment.

• Plant Number.

• Visual Inspection.

  Safe

  At Risk

  N/A

• Electrical Test.

  Safe

  At Risk

  N/A

• Photo of Appliance.

  Media

• Brand of Equipment.

• Type of Equipment.

• Plant Number.

• Visual Inspection.

  Safe

  At Risk

  N/A

• Electrical Test.

  Safe

  At Risk

  N/A

• Photo of Appliance.

  Media

• Brand of Equipment.

• Type of Equipment.

• Plant Number.

• Visual Inspection.

  Safe

  At Risk

  N/A

• Electrical Test.

  Safe

  At Risk

  N/A

• Photo of Appliance.

  Media

• Brand of Equipment.

• Type of Equipment.

• Plant Number.

• Visual Inspection.

  Safe

  At Risk

  N/A

• Electrical Test.

  Safe

  At Risk

  N/A

• Photo of Appliance.

  Media

• Brand of Equipment.

• Type of Equipment.

• Plant Number.

• Visual Inspection.

  Safe

  At Risk

  N/A

• Electrical Test.

  Safe

  At Risk

  N/A

• Photo of Appliance.

  Media

DATE OF NEXT TEST.

• Select date

  Date

PERSON CONDUCTING ELECTRICAL TEST.

• NAME.

• LICENCE NUMBER.

• Signature.

  Sign