• Client/ Site

  • Select date

  • Asset Number

  • Room number

  • Prepared By

LIOM inspection

  • Fittings and fixtures in good condition

  • Is the overload monitor seperate from the Line Isolation Monitor?

  • Labelling in accordance with AS/NZS 3003
    (A) associated circuit breaker and its distribution panel
    (B) unique Identifier e.g. "LIM X"
    (C) Over current Alarm Set Point

  • Push button PHC test

  • Enter PHC results here

Isolation Transformer inspection

  • Fittings and fixtures in good condition?

  • Isolation labelling
    (A) Circuit breaker and Distribution panel
    (B) Unique identifier e.g. "LIM X"
    (C) Manufacturers label intact

  • Sufficient ventilation

  • Isolation transformer is clean and free from dust build up?

  • Circuit breaker rating and type correct for transformer size?
    Refer to manufacturers specifications

Load Bank test

  • LIOM overload alarm activates when rated load is applied

  • LIOM overload alarm activates with in 3-5 seconds of the load being applied

  • Enter load bank results here LIM number / Overload current / Alarm time

  • Is the installation compliant with AS/NZS 3003:2011 & AS/NZS 4510:1990?

  • Add signature

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