Work Approval

Customer Details

  • Customer Name

  • Site Address

Work Details

  • Work Undertaken

  • Materials Used

  • Diagram

Staff Details

  • 1st hour. $120+gst
    Thereafter $75+gst

  • Time - Chris Ellis

  • Staff 2

  • Time

  • Staff 3

  • Time

Authorisation

  • Customer (or Authorised Person) Name

Site Specific Risk Management Form

Applicable Safe Work Method Statements

  • Asbestos

  • Confined Spaces

  • Demolition

  • Excavation and Trenching

  • Hazardous Substances

  • Heights

  • Plant

  • Working near Overhead Powerlines

  • Working on or near a Road

  • Working on or near Exposed Energised Electrical Equipment

Acknowledgement

  • I certify that the above control measures have been implemented.

  • Worker in Charge

  • Staff 1

  • Staff 2

  • Staff 3

Electrical Test Record

Test Record

  • 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.

  • Tested by:

Circuit 1

  • Circuit or Equipment

  • Visual Inspection Complete

  • Circuit Number

  • Protection Size and Type

  • Neutral Number

  • Phase

  • Cable Size

  • Continuity Test - Ohms

  • Insulation Resistance - MOhms

  • Polarity Test

  • Fault Loop Impedance Test - Ohms

  • Operational Test

  • Test Date

Circuit 2

  • Circuit or Equipment

  • Visual Inspection Complete

  • Circuit Number

  • Protection Size and Type

  • Neutral Number

  • Phase

  • Cable Size

  • Continuity Test - Ohms

  • Insulation Resistance - MOhms

  • Polarity Test

  • Fault Loop Impedance Test - Ohms

  • Operational Test

  • Test Date

Circuit 3

  • Circuit or Equipment

  • Visual Inspection Complete

  • Circuit Number

  • Protection Size and Type

  • Neutral Number

  • Phase

  • Cable Size

  • Continuity Test - Ohms

  • Insulation Resistance - MOhms

  • Polarity Test

  • Fault Loop Impedance Test - Ohms

  • Operational Test

  • Test Date

Circuit 4

  • Circuit or Equipment

  • Visual Inspection Complete

  • Circuit Number

  • Protection Size and Type

  • Neutral Number

  • Phase

  • Cable Size

  • Continuity Test - Ohms

  • Insulation Resistance - MOhms

  • Polarity Test

  • Fault Loop Impedance Test - Ohms

  • Operational Test

  • Test Date

Circuit 5

  • Circuit or Equipment

  • Visual Inspection Complete

  • Circuit Number

  • Protection Size and Type

  • Neutral Number

  • Phase

  • Cable Size

  • Continuity Test - Ohms

  • Insulation Resistance - MOhms

  • Polarity Test

  • Fault Loop Impedance Test - Ohms

  • Operational Test

  • Test Date

Completion

  • Job time has been entered

  • Work area is safe for customer to re-enter

  • Test record complete

  • Customer has signed

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