Nurse Call Certificate of Inspection

• Document No:

• Customer

• Site Address
  Address

• Date

  Date

• Arrival Time

  Date

• System Type

• % of system tested

  50%

  100%

Control Panel Items Tested & Inspected

• General State of Panel

  Good

  Fair

  Poor

• Battery Connection

  Good

  Bad

• General Fault Indication

  Yes

  No

  N/A

• Panel Lamp Test

  Pass

  Fail

  N/A

• Silence Resound

  Pass

  Fail

  N/A

• Reset Function

  Pass

  Fail

  N/A

• Sounder Test

  Yes

  No

• Reason

Field Circuits

• All Circuits Respond

  Yes

  No

• Visual State of Wiring

  Good

  Fair

  Poor

• Visual State of Equipment

  Good

  Fair

  Poor

Battery Functions

• Charge Voltage - V

• Alarm Functions with Batteries Disconnected

  Yes

  No

• Battery Size - Ah

• Battery 1 - Ah

• Battery 2 - Ah

• Date on Batteries

Test Completion

• Test result

  Satisfactory

  Unsatisfactory

Signature

• Engineers Signature

  Sign

• Customer Signature

  Sign