ELECTRICALCERTIFICATEOFCOMPLIANCE&ELECTRICALSAFETYCERTIFICATE

REFERENCE/CERTIFICATEIDNO.:
ThisformhasbeendesignedtobeusedbylicensedelectricalworkerstocertifythatinstallationsorPartinstallationsunderPart1or
Part2ofAS/NZS3000aresafetobeconnectedtothespecifiedsystemofelectricalsupply.
LocationDetails:

ContactDetails:
(Nameandaddress)

NameofElectrical Registration/Practising
worker: licencenumber:
Phone&email:
Nameandregistrationnumber
ofperson(s)supervised:

CertificateofCompliance
Typeofwork: Addition Alteration Newwork
Theprescribedelectricalworkis: Lowrisk General Highrisk(Specify):

Meansofcompliance: Part1ofAS/NZS3000 Part2ofAS/NZS3000

AdditionalStandardsorelectricalcodeofpracticewererequired: No Yes(specify):
Dateorrangeofdatesthatprescribedelectricalworkundertaken:
Containsfittingsthataresafetoconnecttoapowersupply? Yes No
Specifytypeofsupplysystem:
Theinstallationhasanearthingsystemthatiscorrectlyrated(whereapplicable) Yes No
Partsoftheinstallationtowhichthiscertificaterelatesthataresafetoconnecttoapowersupply?
All Parts(specify)
Theworkreliesonmanufacturersinstructions: Yes No
Ifyesidentifytheinstructionmanualincludingname,dateandversion.Alsoattachacopyofmanufacturersinstructionstothiscertificate.
(Orprovidereferencetoreadilyaccessibleelectronicformat,egInternetlink.)
Identify:
Link:
Theworkhasbeendoneinaccordancewithacertifieddesign: Yes No
Ifyesidentifythecertifieddesignincludingname,dateandversion.Alsoattachacopyofthecertifieddesigntothiscertificate.
(Orprovidereferencetoreadilyaccessibleelectronicformat,egInternetlink.)
Identify:
Link:
TheworkreliesonaSupplierDeclarationofConformity(SDoC): Yes No
IfyesidentifytheSDoCincludingname,dateandversionOREESSregistration.AlsoattachacopyoftheSDoCtothiscertificate.
(Orprovidereferencetoreadilyaccessibleelectronicformat,egInternetlink.)
Identify:
Link:
TheinstallationhasbeensatisfactorilytestedinaccordancewiththeElectricity(Safety)Regulations2010 Yes
No
DescriptionofWork: TestResults(providevalues)
Polarity
(Independentearth):
Insulationresistance: Ohms
EarthContinuity: Ohms
Bonding: Ohms
FaultLoopimpedance Ohms
Other(specify):

BysigningthisdocumentIcertifythatthecompletedprescribedelectricalworktowhichthisCertificateofCompliance
applieshasbeendonelawfullyandsafely,andtheinformationinthecertificateiscorrect.
Certifierssignature: Date:
ElectricalSafetyCertificate
BysigningthisdocumentIcertifythattheinstallation,orpartoftheinstallation,towhichthisElectricalSafetyCertificate
appliesisconnectedtoapowersupplyandissafetouse.
Certifiers Registration/Practising
name: licencenumber:
Certifiers Certificate ConnectionDate:
signature: IssueDate:
CUSTOMERCOPYTHISISANIMPORTANTDOCUMENTANDSHOULDBERETAINEDFORAMINIMUMOF7YEARS
This Electrical Safety Certificate also confirms that the electrical work complies with the building code for the purposes of Section 19(1)(e) of the Building Act 2004.