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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
Scott Biesiek
Line Isolation Overload Monitor Loadbank Test
Isolation transformer performance testing for LIOMs units used in Medical Facilities
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