LEAUBUND Certificate of Test

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Certificate of:

• Testing and Compliance - Electrical Installations - Issued in accordance with s159 of the Electrical Safety Regulation 2002

  Yes

  No

  N/A

• Testing and Compliance - Electrical Equipment - Issued in accordance with s15 of the Electrical Safety Regulation 2002

  Yes

  No

  N/A

• Enter the Project Number

• Details of Electrical Installation/Equipment Tested:

Certification

• Date of Test

  Date

• Electrical Contractor's License Number: 70847

• Name on Contractor's License: Laser Electrical Bundaberg

• Phone Number: 07 41515683

• For Electrical Installations, this certifies that the electrical installation, to the extent it is affected by the electrical work, has been tested to ensure that it is electrically safe and is in accordance with requirements of the wiring rules and any other standard applying under the Electrical Safety Regulation 2002 to the electrical installtion.

• For Electrical Equipment, this certifies that the electrical equipment, to the extent it is affected by the electrical work, is electrically safe.

Electrical Worker

• Name:

  Sign

• Electrical Worker License Number:

  53902

  119551

  126043

  72828

• Date:

  Date