Title Page
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Address
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Conducted on
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Name of the licensed or registered electrician who conducted the check
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The licence or registration number of the licensed or registered electrician who conducted the check
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The Date the check was conducted
EXTENT OF THE ELECTRICAL INSTALLATION AND LIMITATIONS OF THE SAFETY INSPECTION AND TESTING
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Tick the below installations that are present and accessible that are included in the safety check (leave unticked if not included in report, leave notes at bottom of section as to why, unless not present at property)
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Main Switchboard
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Main Earthing System
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Kitchen
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Bathroom (Main)
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Other Bathrooms/Ensuites
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Bedroom (Main)
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Other Bedrooms
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Living Room
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Other Living areas
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Laundry
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Garage/outdoor building or shed
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Solar/Battery system
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Electric water heater
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Dishwasher
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Electric room/ space heaters/ wall heaters
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Swimming pool equipment
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Notes (Any limitations of the safety inspection and testing)
SAFETY CHECK - VERIFIED BY VISUAL INSPECTION
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As far as practicable a VISUAL INSPECTION of the following items have been carried out per requirements of section 4 of AS/NZS 3019:2007 Electrical installations - Periodic Verification:
Tick the below installations, fittings and fixtures included in the visual inspection (Select: Not Available if not present, leave a note as to why not visually inspected) -
Consumer Mains
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Switchboard
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Exposed earth electrode/Buried Earth
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Metallic water pipe bond
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RCD's (Safety Switches)
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Circuit protection (circuit breakers/fuses)
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Socket outlets (GPO)
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Light Fittings
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Electric Water Heater
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Air Conditioners
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Space Heaters
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Cooking equipment
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Dishwasher
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Exhaust Fans / IXL Tastics
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Ceiling Fans
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Washing Machine ? Dryer
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Installation Wiring
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Solar & other renewable systems
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Swimming pool equipment
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Vehicle Chargers
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Powered Garage Door
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Note: (leave a note If one of the above was present and as to why was not visually inspected)
SAFETY CHECK - VERIFIED BY MINIMAL TESTING
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As far as practicable MINIMUM TESTING of the following items has been carried out per the requirements of Section 4 of AS/NZS 3019:2007 Electrical Installations - Periodic Verification
Pass or Fail the below installations, fittings and fixtures included in the minimal testing (leave unticked if not included, leave a note as to why not tested, unless not present at property) -
Consumer Mains
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Circuit Protection (Circuit Breakers / fuses
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RCD's (Safety Switches)
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Socket Outlets (GPO)
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Light Fittings
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Electric water heater
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Air Conditioners
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Cooking equipment
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Dishwasher
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Solar and other renewable systems
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Swimming pool equipment
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Vehicle Chargers
Earthing Continuity Testing
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Main Earth Conductor
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Switchboard enclosure
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Metallic water pipe bond
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Socket outlets (GPO)
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Light fittings
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Exhaust fans
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Ceiling Fans
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Electric water heater
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Air Conditioners
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Cooking Equipment
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Dishwasher
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Solar and other renewable systems
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Swimming pool equipment
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Vehicle Chargers
Safety Switch Testing
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(RCD testing using the RCD's Integral Testing Device)
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Photos of switchboard (Cover on and Cover off)
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Does the property have an RCD?
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Power Outlet RCD's
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Lighting RCD's
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Other RCD's
OBSERVATIONS AND RECOMMENDATIONS FOR ANY ACTIONS TO BE TAKEN:
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The Following observations and recommendations are made: