Title Page
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
REPORT OF INSPECTION
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Make & Model
Appliance Type
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Appliance Type
- Hammer Drill
- Heat Gun
- Angle Grinder
- Screw Gun
- Mag Drill
- Reamer
- Pistol Drill
- Drill
- Sander
- Charger
- Extension Lead
- Resip Saw
- Reel Extention
- Laptop
- Printer
- Hoover
- Chop Saw
- Jig Saw
- Wielding Machine
- Other
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As item is not listed please give description below
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Make & Model
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Serial Number
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Appliance Passed
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Pat Test Date
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Next pat test date due 3 months after date listed above
Inspection Carried Out
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Inspection carried out by
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Date of Inspection
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Next Inspection to be carried within one month from date noted above