SECTION A. DETAILS OF THE CLIENT

Client:
Address:

SECTION B. REASON FOR PRODUCING THIS REPORT

Reason:
Date(s) on which inspection and testing was carried out:

SECTION C. DETAILS OF THE INSTALLATION

Occupier:
Address:
Description of Premises:	Residential Commercial Industrial Other:
Evidence of Alterations or Additions:
If ‘Yes’, estimate age (years):
Date of previous inspection:
Installation records available:
Estimated age of the wiring system:
District Network Operator (DNO):
Sub-Station Number:

SECTION D. EXTENT OF THE INSTALLATION AND LIMITATIONS

SECTION E. SUMMARY OF THE CONDITION OF THE INSTALLATION

General condition:

Overall assessment:

SECTION F. RECOMMENDATIONS

Date of Next Inspection:

SECTION G. DECLARATION

Inspected and tested by:

Report authorised by: