Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Part 1: Details of the Minor Works
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Client:
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Date minor works completed:
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Contract reference (if any):
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Description of the minor works:
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Details of departures, if any, from BS 7671 (as amended):
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Location/address of the minor works:
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Part 2: Details of the Modified Circuit
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System type and earthing arrangements:
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Protective measure(s) against electric shock:
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Overcurrent protective device for the modified circuit:
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BS (EN):
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Type:
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Rating (A):
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Residual current device (if applicable):
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BS (EN):
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Type:
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I^n (mA)
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Details of wiring system used to modify the circuit:
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Type:
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Reference method:
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CSA of lives (mm^2):
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CSA of CPC (mm^2):
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Where the measure for protection against electric shock is ADS, insert maximum disconnection time permitted by BS7671 (s):
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Maximum Zs permitted by BS 7671
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Comments, if any, on existing installation, including adequacy of earthing and bonding arrangements (see regulation 132.16):
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Part 3: Inspection and Testing of the Modified Circuit and Related Parts
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Confirmation that necessary inspections have been undertaken.
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Circuit resistance:
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R1+R2
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R2
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Insulation resistance. (In a multi-phase circuit, record the lower or lowest value, as appropriate)
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Line/Line
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Line/Neutral
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Line/Earth
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Neutral/Earth
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Instrumental Serial No(s).
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Confirmation of the adequacy of earthing
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Confirmation of the adequacy of protective bonding
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Confirmation of correct polarity
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Maximum measured earth fault loop impedance, Zs
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RCD operating time at l^n (if RCD fitted)
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RCD operating time at 5l^n, if applicable
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Part 4: Declaration:
I/We certify that the minor electrical installation works, as detailed in Part 1 of this certificate, does not impair the safety of the existing installation, that the said works have been designed, constructed, inspected, tested and verified in accordance with BS 7671, amended on the date shown and that, to the best of my/our knowledge and belief, at the time of my/our inspection, the work complied with BS 7671 expect as detailed in Part 1 of this certificate. -
Date and time:
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The results of the inspection and testing reviewed by the qualified supervisor.
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For and on behalf of:
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Address and Postcode:
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Name and signature:
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Position
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Date
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Name and signature:
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Position
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Date
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Registration No.
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Branch No. (If Applicable)
