Online Form - Certificate of Electrical Compliance

Health (Miscellaneous Provisions) Act 1911 (Regulation 10)

Health (Public Buildings) Regulations 1992

Certification

To the City / Town / Shire of*

Date*

Name and initial of occupier*

Details of Building

Name*

Building Number on Street*

Street*

Suburb / Town*

Postcode*

Particulars of Installation

Describe any electrical work for which you are not responsible in there premises:*

Please upload a photo or document of a signature of a licensed electrical contractor or electrical worker authorised to sign on behalf of the electrical contractor / in-house electrical installer*

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Contractor's / in-house electrical installer's Business Name*

Contractor's / in-house electrical installer's Registration Number*

Contractor's / in-house electrical Installer's Address*

Contractor's / in-house electrical Installer's Telephone Number*

Declaration

I/We declare that all details in this form are true and correct. Please be advised providing false information may be an offense.

I hereby certify that the electric light and / or power installation, alteration, addition at the above-mentioned premises has been carried out in accordance with the Health (Public Buildings) Regulations 1992*

YesNo

Name of Applicant*

Contact Number*

Signature of Applicant*

Date*