Title Page

  • Audit Title

  • Conducted on

  • Prepared By:

  • Client:

  • Enter Unlisted Client:

  • Facility:

  • Enter Unlisted Site or Facility:

  • Building, Floor, Ward & Room Details:

  • Details of applicable Modifications and/or Repairs to Patient Area:

  • Personnel responsible for installation, modification or repairs to Patient Area:

  • Personnel Responsible for Testing, Verification and Re-Commisioning of Patient Area:

  • 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?

  • ENTER BARCODE

GENERAL REQUIREMENTS FOR BODY-PROTECTED AND CARDIAC-PROTECTED ELECTRICAL AREAS

  • 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

  • 6.2.2 Compliance: Verify if not existing CPA or BPA, then full <br>compliance with this Standard required.

  • 6.2.5 Compliance: Verify EP wiring system.

  • 6.2.3 Compliance: Verify inspection within last 12 months.

  • Capture Image of Patient Area Sign ensuring Test Dates are visible:

  • 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.

  • Capture Image of Installed/Modified Equipment relevent to audit:

  • End of Audit.

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