Test Certificate

• Technician

• Location
  Address

• Asset ID

• Examination & Test (IMCA D 018 Worksheet)

  Sheet 11

• Inspection type

  Select 1 Monthly 3 Monthly 6 Monthly Yearly Visual Inspection Re-certified

  • 1 Monthly
  • 3 Monthly
  • 6 Monthly
  • Yearly
  • Visual Inspection
  • Re-certified

Safety

• Isolations in place

  Yes

  No

  N/A
Description

• Cable Condition

  Good

  Fair

  Poor

  N/A

• Cable ID

• Serial No.

• Cores

Testing

• Continuity

• Resistance Value

• Insulation Tested

  >55MΩ

  >250 MΩ

  >500 MΩ

  >1000 MΩ

  >2GΩ

• Yes

  No

  N/A

• Results

  Pass

  Fail

  N/A

Notes & Expectations

• undefined

Technician or Tester

• Name

• Signature

  Sign

• Date

  Date