Title Page
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Conducted on
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Prepared by
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Location
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Store Name & Number
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MS Number
To add another asset, repeat this step until all items are covered.
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Description
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Appliance ID
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Location
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Class 1 or Class 2
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Visual Inspection
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Pass Or Fail
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Test Date- Retest 12 months from this date
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Any other Information
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Any Pictures if required
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Test Equipment Information ( Make, Model, Serial Number )
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Number of items tested, Number of items failed
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Please Sign
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This is to certify that the Electrical Appliances detailed in the above record sheets have been tested for electrical safety in accordance with the institute of Electrical Engineers code of practise for in service inspection and testing of Electrical Equipment. Please note that does not guarantee the future safety of the appliance nor does it guarantee the correct operation of the equipment for any length of time. The user of the appliance should pay particular attention to any defect or fault that may occur during future use and if there is any doubt as to the safety and correct operation, the appliance should be removed from service for further inspection by a competent person.
