Site Information

  • Document No.

  • Job No.

  • Client

  • Site

  • Engineer



  • What is the inspection frequency?


  • How many dwellings in the block?

Grade D System

  • Communal system tested?

  • System ok?

  • Details

  • Flats tested?

  • System ok?

  • Details

  • Flats that were tested?

  • List any defects

Emergency Lighting Inspection

  • Does the site have emergency lightning?

  • How many?

  • Three hour drain down Completed?

  • Issues

  • Does this block have a Landlords power supply available?

  • System Status

  • Remediation Requirements



  • Resident available?

  • Resident Declaration: All work has been carried out to my satisfaction

  • Signature:

  • Date:

  • SCCI Alphatrack Engineer(s) Declaration: I/We, being the competent person(s) for the servicing, certify that the above work complies to the best of my/our knowledge and belief with the recommendations of BS5839-1 2002 clause 45 and/or BS5266-1 / BS5266-8: 2004 section 7 with the exception of any variations and deviations.

  • Signature:

  • Date:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.