Flexi -3G Installation & Commissioning Manual
Chapter 9. Appendices
Page 92 of 94
Document No: - 4493-CM-EN-10989402
Copyright © 2008-2009 Eaton Corporation. All Rights Reserved
Appendix I. Sample Electrical Completion & Initial Inspection &
Testing Certificate
Installation address:
Installation Type (New,
addition/modification to existing
installation, etc.):
Extent and description of installation
covered by this certificate:
Design:
being the person(s) responsible for the design of the electrical installation (as indicated by my/our signatures
below), particulars of which are described above, have exercised reasonable skill and care when carrying out the
design hereby CERTIFY that the said work for which I/we have been responsible is to the best of my/our
knowledge and belief in accordance with BS7671 amended to 2001 except for the departures, if any, detailed as
follows:
Details of departures from BS7671 as amended (Regs 120-02, 120-05) or local regulations:
The extent of liability of the signatory or signatories is limited to the work described above as the subject of this
certificate.
Signature:
Date:
Name:
Company Name : Address:
Signature:
Date:
Name: (Designer 2, where there is mutual responsibility
for design)
Company Name
Address:
Construction:
being the person(s) responsible for the construction of the electrical installation (as indicated by my/our
signatures below), particulars of which are described above, have exercised reasonable skill and care when
carrying out the construction hereby CERTIFY that the construction work for which I/we have been responsible is
to the best of my/our knowledge and belief in accordance with BS7671 amended to (date) except for the
departures, if any, detailed as follows:
Details of departures from BS7671 as amended (Regs 120-02, 120-05):
The extent of liability of the signatory or signatories is limited to the work described above as the subject of this
certificate.
Signature:
Date:
Name:
(Constructor)
Company Name
Address:
Inspection & Testing:
being the person(s) responsible for the inspection & testing of the electrical installation (as indicated by my/our
signatures below), particulars of which are described above, have exercised reasonable skill and care when
carrying out the inspection & testing hereby CERTIFY that the work for which I/we have been responsible is to the
best of my/our knowledge and belief in accordance with BS7671 amended to (date) except for the departures
from the Regulations and items not tested, if any, detailed as follows:
Details of departures from BS7671 as amended (Regs 120-02, 120-05) and items not tested:
The extent of liability of the signatory or signatories is limited to the work described above as the subject of this
certificate.
Signature:
Date:
Name:
(Inspector)
Company Name
Address:
Next Inspection:
I/We the designer(s), recommend that this installation be further inspected and tested after an interval of not more
than: .
