Information
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Client / Site
Work Approval
Customer Details
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Customer Name
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Site Address
Work Details
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Work Undertaken
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Materials Used
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Diagram
Staff Details
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Staff 1
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Time
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Staff 2
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Time
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Staff 3
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Time
Authorisation
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Intechsys
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Customer
Site Specific Risk Management Form
Applicable Safe Work Method Statements
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Asbestos
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Confined Spaces
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Demolition
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Excavation and Trenching
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Hazardous Substances
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Heights
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Plant
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Working near Overhead Powerlines
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Working on or near a Road
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Working on or near Exposed Energised Electrical Equipment
Acknowledgement
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I certify that the above control measures have been implemented.
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Worker in Charge
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Staff 1
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Staff 2
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Staff 3
Electrical Test Record
Test Record
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I certify that the electrical installation to the extent that it is effected by the electrical work, has been tested to ensure it is electrically safe and is in accordance with the requirements of the wiring rules and any other standard applying to the electrical installation under state legislation.
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Tested by:
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Electrical worker in charge:
Circuit 1
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Circuit or Equipment
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Visual Inspection Complete
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Circuit Number
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Protection Size and Type
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Neutral Number
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Phase
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Cable Size
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Continuity Test - Ohms
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Insulation Resistance - MOhms
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Polarity Test
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Fault Loop Impedance Test - Ohms
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Operational Test
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Test Date
Circuit 2
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Circuit or Equipment
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Visual Inspection Complete
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Circuit Number
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Protection Size and Type
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Neutral Number
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Phase
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Cable Size
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Continuity Test - Ohms
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Insulation Resistance - MOhms
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Polarity Test
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Fault Loop Impedance Test - Ohms
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Operational Test
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Test Date
Circuit 3
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Circuit or Equipment
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Visual Inspection Complete
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Circuit Number
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Protection Size and Type
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Neutral Number
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Phase
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Cable Size
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Continuity Test - Ohms
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Insulation Resistance - MOhms
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Polarity Test
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Fault Loop Impedance Test - Ohms
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Operational Test
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Test Date
Circuit 4
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Circuit or Equipment
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Visual Inspection Complete
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Circuit Number
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Protection Size and Type
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Neutral Number
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Phase
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Cable Size
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Continuity Test - Ohms
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Insulation Resistance - MOhms
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Polarity Test
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Fault Loop Impedance Test - Ohms
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Operational Test
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Test Date
Circuit 5
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Circuit or Equipment
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Visual Inspection Complete
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Circuit Number
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Protection Size and Type
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Neutral Number
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Phase
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Cable Size
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Continuity Test - Ohms
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Insulation Resistance - MOhms
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Polarity Test
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Fault Loop Impedance Test - Ohms
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Operational Test
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Test Date