Inspection Report Cardiac-Protected Area

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• INSPECTION REPORT FOR CARDIAC-PROTECTED ELECTRICAL AREAS
  
  CVSG ASSET SERVICES PTY LTD
  ABN 62 128 821 698
  
  Conducted in accordance with:
  AS/NZS 3003:2011 ELECTRICAL INSTALLATIONS - PATIENT AREAS

INSPECTION DETAILS

• Select date

  Date

• NAME OF PERSON UNDERTAKING TESTS

• NAME OF FACILITY?

• Add location
  Address

• LOCATION OF TEST - ROOM NO.?

• ASSET BARCODE AVAILABLE?

  YES

  NO

UNINTERRUPTIBLE POWER SUPPLIES (UPS)

• Confirm that UPS status indicator performance is routinely verified.

  PASS

  FAIL

  N/A

INSPECTION

• All electrical equipment & fittings in good condition?

  PASS

  FAIL

  N/A

LABELLING

• Circuit identification visible and intact on each?

  Yes

  No

  N/A

• Relevant electrical points labelled to identify associated RCDs?

  Yes

  No

  N/A

• Circuit identification visible and intact on each LIM?

  Yes

  No

  N/A

• Relevant electrical points labelled to identify associated LIMs?

  Yes

  No

  N/A

• Overload monitors labelled with alarm setting?

  Yes

  No

  N/A

• Socket-outlets protected by RCD labelled ‘RCD PROTECTED’?

  Yes

  No

  N/A

• Socket-outlets protected by Isolating transformers labelled ‘ISOLATING TRANSFORMER PROTECTED’?

  Yes

  No

  N/A

• Socket-outlets intended for cleaning purposes labelled ‘CLEANING PURPOSES ONLY’?

  Yes

  No

  N/A

• Body-protected electrical area sign:<br>Still visible.<br>Labelled with current inspection date.<br>Labelled with identity of authorized person.<br>Labelled with next test date.

  Yes

  No

  N/A

SOCKET OUTLETS

• Socket-outlets coloured according to type of supply

  PASS

  FAIL

  N/A

• If RCD protected, power-available indicator operational?

  PASS

  FAIL

  N/A

• Number of socket-outlets and permanently wired electrical equipment protected by RCD does not exceed 12?

  Yes

  No

  N/A

• On/off luminous indicators operational, if applicable?

  PASS

  FAIL

  N/A

• Socket-outlets double-poled if protected by a transformer-isolated supply?

  PASS

  FAIL

  N/A

• All socket-outlets below 2.3 m protected by LPD?

  PASS

  FAIL

  N/A

• Confirm each socket-outlet trips the RCD when fault applied?

  PASS

  FAIL

  N/A

• Confirm each socket-outlet causes a response on LIM when a fault is applied?

  PASS

  FAIL

  N/A

• Confirm that RCDs do not protect socket-outlets in another patient location?

  PASS

  FAIL

  N/A

EARTHING

• Confirm that the earth pin of all socket-outlets below 2.3 m are earthed to less that 0.1 Ω?

  PASS

  FAIL

  N/A

• Confirm that all permanently wired appliances with conductive parts below 2.3 m are earthed to less that 0.1 Ω with respect to EP junction node or other appliances.

  PASS

  FAIL

  N/A

POTENTIAL DIFFERENCE BETWEEN ACCESSIBLE METAL EQUIPMENT

• Confirm that the potential difference does not exceed 50 mV between EP junction and—

• Earthing pins of at least 2 socket-outlets in each patient location.

  PASS

  FAIL

  N/A

• Reticulated plumbing pipework services<br>

  PASS

  FAIL

  N/A

• Accessible conductive parts of permanently wired electrical equipment that are accessible in patient environment:<br>Surgical luminaires and patient examination lights.<br>Pendants.<br>Imaging systems.<br>Equipment mounting rails.

  Yes

  No

  N/A

RCD SENSITIVITY (AUS)

• Confirm that the RCD trips at a value greater than 4.5 mA and less than 10.5mA

  PASS

  FAIL

  N/A

RCD TRIPPING TIMES (AUS)

• Confirm this by repeating the test at least 2 times.

  PASS

  FAIL

  N/A

• Record the worst case (mA)

RCD SUPPLY AVAILABLE INDICATOR LIGHTS

• If applicable, confirm that they are operational.

  PASS

  FAIL

  N/A

AUDIO VISUAL RCD TRIP INDICATORS

• If applicable, confirm that they are operational.

  PASS

  FAIL

  N/A

PROSPECTIVE HAZARD CURRENT OF INSUALTION

• Ensure PHC is less than 2 mA when no appliance is plugged in.

  PASS

  FAIL

  N/A

• Record hazard current (mA)

LIM PROSPECTIVE HAZARD CURRENT ALARM

• Confirm that the LIM alarms between 17 and 19 mA. Record alarm current (mA)

OVERLOAD MONITORS

• Confirm that a load of 110–120% of transformer rated current causes the alarm to activate in 3–5 s

  PASS

  FAIL

  N/A

INSPECTION COMPLETE

• INSTALLATION COMPLIANT WITH AS/NZS 3003:2011?

  YES

  NO

• Add signature

  Sign