Electrical Certificate of Compliance & Electrical Safety Certificate
Reference/Certificate ID No.:
This form has been designed to be used by licensed electrical workers to certify that installations or Part installations under Part 1 or
Part 2 of AS/NZS 3000 are safe to be connected to the specified system of electrical supply.
Part 2 of AS/NZS 3000 are safe to be connected to the specified system of electrical supply.
Location Details:
Contact Details:
(Name and address)
(Name and address)
Name of Electrical
worker:
worker:
Registration/Practising
licence number:
licence number:
Phone & email:
Name and registration number
of person(s) supervised:
of person(s) supervised:
Certificate of Compliance
Type of work:
Addition
Alteration
New work
The prescribed electrical work is:
Low risk
General
High-risk (Specify):
Means of compliance:
Part 1 of AS/NZS 3000
Part 2 of AS/NZS 3000
Additional Standards or electrical code of practice were required:
No
Yes (specify):
Date or range of dates that prescribed electrical work undertaken:
Contains fittings that are safe to connect to a power supply?
Yes
No
Specify type of supply system:
The installation has an earthing system that is correctly rated (where applicable)
Yes
No
Parts of the installation to which this certificate relates that are safe to connect to a power supply?
All
Parts (specify)
The work relies on manufacturers instructions:
Yes
No
If yes – identify the instruction manual including name, date and version. Also attach a copy of manufacturer’s instructions to this certificate.
(Or provide reference to readily accessible electronic format, eg Internet link.)
Identify:
Link:
The work has been done in accordance with a certified design:
Yes
No
If yes – identify the certified design including name, date and version. Also attach a copy of the certified design to this certificate.
(Or provide reference to readily accessible electronic format, eg Internet link.)
Identify:
Link:
The work relies on a Supplier Declaration of Conformity (SDoC):
Yes
No
If yes - identify the SDoC including name, date and version OR EESS registration. Also attach a copy of the SDoC to this certificate.
(Or provide reference to readily accessible electronic format, eg Internet link.)
Identify:
Link:
The installation has been satisfactorily tested in accordance with the Electricity (Safety) Regulations 2010
No
Yes
Description of Work:
Test Results (provide values)
Polarity
(Independent earth):
(Independent earth):
Insulation resistance:
Ohms
Earth Continuity:
Ohms
Bonding:
Ohms
Fault Loop impedance
Ohms
Other (specify):
By signing this document I certify that the completed prescribed electrical work to which this Certificate of Compliance applies has been done lawfully and safely, and the information in the certificate is correct.
Certifier’s signature:
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Date:
Electrical Safety Certificate
By signing this document I certify that the installation, or part of the installation, to which this Electrical Safety Certificate applies is connected to a power supply and is safe to use.
Certifier’s
name:
name:
Registration/Practising
licence number:
licence number:
Certifier’s
signature:
signature:
Certificate
Issue Date:
Issue Date:
Connection Date:
CUSTOMER COPY – THIS IS AN IMPORTANT DOCUMENT AND SHOULD BE RETAINED FOR A MINIMUM OF 7 YEARS
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.