Original Certificate Certificate reference: ELECTRICAL ...

1 Original CertificateCertificate reference : ELECTRICAL INSTALLATION CONDITION REPORT (Requirements for ELECTRICAL Installations BS 7671 IEE Wiring Regulations)DETAILS OF THE CLIENTName:Address:PURPOSE FOR WHICH THIS REPORT IS REQUIREDThis report must be used only for reporting on the condition of an existing (s):DETAILS OF THE INSTALLATIONO ccupier:Address:Description of Premises:Domestic Commercial Industrial OtherEstimated age of the ELECTRICAL Installation:YearsEvidence of Alterations or Additions: If yes estimated age:YearsDate of previous Inspection: ELECTRICAL Installation Certificate No: or previous Periodic Inspection report No:Records of installation held by: EXTENT OF THE INSTALLATION AND LIMITATIONS OF THE INSPECTION AND TESTINGE xtent of the ELECTRICAL installation covered by this report:Agreed Limitations (including the reasons), if any, on the inspection and testingOperational limitations including the reasons (see page No.)

2 This inspection has been carried out in accordance with BS 7671:2008, as amended. Cables concealed within trunking and conduits, or cables and conduits concealed under floors, in roof spaces and generally within the fabric of the building or under ground have not been OF THE CONDITION OF THE INSTALLATIONG eneral condition of the installation (in terms of ELECTRICAL safety): If necessary, continue on additional page(s)? No Yes Specify page Overall assessment of the installation:SATISFACTORY / UNSATISFACTORY(Delete as appropriate)An Unsatisfactory assessment indicates that dangerous and/or potentially dangerous conditions have been reference .

3 ELECTRICAL INSTALLATION CONDITION REPORT - Report pages including inspection and test schedules 1 of 9 OBSERVATION AND RECOMMENDATIONS FOR ACTIONS TO BE TAKENR eferring to the attached Schedules of Inspection and Test Results and subject to the limitations; There are no item adversely affecting ELECTRICAL safety, or The following observations and recommendations for N/Aare madeItem No*CodeInvestigation required?1 Additional Pages?

4 No Yes Specify page *One of the following codes, as appropriate, has been allocated to each of the observations made above to indicate to the person(s) responsible for the installation the degree of urgency for remedial action: Code C1 "Danger Present". Risk of injury. Immediate remedial action required. Code C2 "Potentially dangerous". Urgent remedial action required. Code C3 "Improvement recommended". Please see the notes for recipient for guidance regarding the Classification remedial action required for items:Urgent remedial action required for items:Further investigation required for items:Improvement recommended for items.

5 DECLARATIONI/We, being the person(s) responsible for the inspection and testing of the ELECTRICAL installation (as indicated by my/our signature(s) below, particulars of which are described above, having exercised reasonable skill and care when carrying out the inspection and testing, hereby Certify that the information on this report, including the observations and the attached schedules, provides an accurate assessment of the condition of the ELECTRICAL installation taking into account the stated extent of the installation and the limitation of the inspection and further declare that in my/our judgement.)

6 The said installation was overall in condition at the time of the inspection we carried out, and that it should be further inspected as , TESTING AND ASSESSMENT BY:REPORT REVIEWED AND CONFIRMED BY:Signature:Signature:Name : (CAPITALS)Name : (CAPITALS)Position:(Registered Qualified Supervisor for the approved contractor at J)Date:Date:Report reference : ELECTRICAL INSTALLATION CONDITION REPORT - Report pages including inspection and test schedules 2 of 9 SCHEDULES AND ADDITIONAL PAGESS chedule of items inspected Page No.

7 4,5,6,7 Additional pages, including additional source(s) data sheets: Page No(s):Schedule of Circuit Details for the installation:Page No(s):8 Schedule of Test Results for the installation:Page No(s):The pages identified here form an essential part of this report. The report is valid only if accompanied by all the schedules and additional pages identified INSPECTIONWe recommend that this installation is further inspected and tested after an interval of not more than Provided that any items which have been attributed a Recommendation Code C1 and C2 (require urgent attention) are remedied without delay and as soon as possible respectively.

8 Items which have been attributed a Recommendation Code C3 should be actioned as soon as practicable (see F).DETAILS OF ELECTRICALCONTRACTOR Trading Title: Address:Telephone number: Fax number:Registration number Postcode:Branch number: (if applicable)SUPPLY CHARACTERISTICS AND EARTHING ARRANGEMENTSTick boxes and enter details, as appropriate System Type(s) Number and Type of Live Conductors Nature of Supply Parameters Characteristics of Primary supply Overcurrent Protective Device(s)TN-S TN-C-S TN-C TT IT AC DC 1-phase(2 wire) 1-phase(3 wire) 2-phase(3 wire) 3-phase(3 wire) 3-phase(4 wire) 2 pole 3 pole other Other(Please state) Nominal Voltage U (1) VNominal frequency f (1)

9 HzProspective fault current (2/3) kAExternal earth fault loop impedance Ze (3/4) Number of supplies1) by enquiry NOTES: (2) by enquiry or by measurementBS(EN)Type Rated current AShort-circuit capacitykA(3) where more than one supply, the higher or highest values(4) by measurementPARTICULARS OF INSTALLATION AT THE ORIGIN Tick boxes and enter details, as appropriateMeans of earthingDetails Installation Earth Electrode (where applicable)Distributor's facility Type:(eg rod(s), tape etc) Location: Maximum Demand: kVA/AmpsInstallation earth electrode Electrode resistance, RA: Method of measurement:Protective measures against electricShock: # Main Switch or Circuit BreakerEarthing and Protective Bonding ConductorsType (BS(EN) Voltage Rating VEarthing conductorConductor csa mm2No of PolesRated current I n AConductor material Continuity check ( )Supply conductors.

10 Material RCD operating current I n mABonding of extraneous-conductive-parts ( )Gas service Lighting Supply conductors:csa mm2 RCD operating time (at I n) msWater service Structural steel Oil service Other service(s) Report reference : ELECTRICAL INSTALLATION CONDITION REPORT - Report pages including inspection and test schedules 3 of 9 INSPECTION SCHEDULE FOR DISTRIBUTION BOARDS AND CIRCUITSItemDescriptionOutcome*Location Condition/adequacy of distributor s supply intake cut-out/fuse(s) tails - tails - of main isolation (where present)