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*

Maximum size of ALL attachments is 976.56 MB

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*