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Electrical Test & Inspection Certificate

Test results record — AS/NZS 3760 & AS/NZS 3000

Company logo

PAGE 1 OF 2

Tester & Site Details

Date

Tester name

Licence / Accred. no.

Tester serial no.

Calibration date

Site / Location

Client / Company

Items Tested

Record test results for each item. P = Pass, F = Fail. Earth in Ω, Insulation in MΩ, RCD in ms.

#	Description	Asset ID / Tag	V	Visual	Earth Ω	Ins. MΩ	RCD ms	Pol.	Result	Next Test Due
1
2
3
4
5
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8
9
10
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Electrical Test & Inspection Certificate - Page 2 of 2

Site

Date

Tester

Items Tested (continued)

#	Description	Asset ID / Tag	V	Visual	Earth Ω	Ins. MΩ	RCD ms	Pol.	Result	Next Test Due
13
14
15
16
17
18
19
20

Test Equipment

Instrument make/model

Serial no.

Calibration date

Calibration due

Test Standards Applied

AS/NZS 3760 AS/NZS 3000 Other:

Failed Items Register

#	Description	Fault	Action Taken
1			Tag out / Repair / Dispose
2			Tag out / Repair / Dispose
3			Tag out / Repair / Dispose
4			Tag out / Repair / Dispose

Total Tested

Passed

Failed

Tester Declaration

I certify that the above items have been tested and inspected in accordance with the applicable Australian Standard and the results are a true record of the testing performed.

Tester Sign-off

Signature

Print name

Date

Client Acknowledgement

Signature

Print name

Date