Title Page
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Audit Title
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Conducted on
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Prepared By:
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Client:
- LendLease
- Spotless
- Queensland Health
- Compass
- HealthScope
- Honeywell
- Other/Not Listed
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Enter Unlisted Client:
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Facility:
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Enter Unlisted Site or Facility:
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Building, Floor, Ward & Room Details:
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Details of applicable Modifications and/or Repairs to Patient Area:
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Personnel responsible for installation, modification or repairs to Patient Area:
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Personnel Responsible for Testing, Verification and Re-Commisioning of Patient Area:
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MODIFICATION/ADDITION INSPECTION REPORT FOR PATIENT AREAS
CVSG ASSET SERVICES PTY LTD
ABN 62 128 821 698
Conducted in accordance with:
AS/NZS 3003:2011 ELECTRICAL INSTALLATIONS - PATIENT AREAS -
ASSET BARCODE AVAILABLE?
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ENTER BARCODE
GENERAL REQUIREMENTS FOR BODY-PROTECTED AND CARDIAC-PROTECTED ELECTRICAL AREAS
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2.1 Body-protected or cardiac-protected electrical areas shall not occur in the same room?<br>Ensure Patient Area has Cardiac or Body Protected Classification.
ALTERATIONS, ADDITIONS AND REPAIRS TO ELECTRICAL INSTALLATIONS IN PATIENT AREAS - ALTERATIONS AND ADDITIONS
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6.2.2 Compliance: Verify if not existing CPA or BPA, then full <br>compliance with this Standard required.
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6.2.5 Compliance: Verify EP wiring system.
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6.2.3 Compliance: Verify inspection within last 12 months.
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Capture Image of Patient Area Sign ensuring Test Dates are visible:
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6.2.4 Compliance: Verify % increase in socket-outlets. If 10% or <br>more increase, then all in patient area to comply with colour <br>requirements.
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Capture Image of Installed/Modified Equipment relevent to audit:
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End of Audit.
