GP/1F

PERIODIC I SPECTION REPORTFORAN ELECTRICAL INSTALLATIONIssued in accordance with British Standard BS 7671- Requ

See reve"e of this page for e.planalol'( notes relating to NICEICsoftware endo"emenl

A. DETAILS OF THE CLIENT

Client ~r .():,...M~ \ \)..fa,f\ Address: ~ ~C) \ \ \ ('. ex Os.Q_

L')'MM w A \3 C\{>7..

B. PURPOSE OF THE REPORT This Periodic Inspection Report must be used only for reporting on the condition of an existing installation.

Purpose for which -ro ~St=-o-bl.....t.h'" \ ~ ~ \ f'~<c.o......LLoJ:::" of' \~ \ r-: So.k ,S~ ""'_cl::-or~this report is required: d ..._)

Cc("\ ,bOA f'or COi'\'c1 {\ \..)e..c\ ~<2.r~'ca_

C. DETAILS OF THE INSTALLATIONDomestic Commercial

y/Industrial

Description ofpremises:

Dther:(Please state) -

Dccupier: ---Address: A-ue..JEstimated age of the electrical installation: IS" }'laears

Postcode:~s.- SA-z._ Evidenceof a~era~ons '-I cor additions le.:...)

If yes,estimated age S years

Date of previous inspection: ~OT I..( f\C) 1-.) (\ Electrical Installation Certificate No or previous Periodic Inspection Report No: NA

Records of installation available: N f\- Records held by:

. b.-EXTENT OF THE INSTALLATION1AND'LlMITATIONS:OF~THErjNS-PEtTlbN' A'i\f5"tESTING· _,

Extent of the electrical installation covered by this report

A- ~ \(\~pQ..d=.'O" o\- ~~ ,",''ICed ~Irl~ AS PerClrc\..)11:: cte..~I~

Agreed limitations, if any, on the inspection and testing:

:ScOla o\- Ac~o\\Q»~ A-cQ.5S

T ~~~ V\o..J..)Q..

'-.)~ \(\A.a_d~ 0....'000::2... ~ 0...\ ~.Q

~ re.Mo.:ec) I

CQ.J.ll~ •

This inspection has been carried out ifl accordance with BS 7671: 2001, as amended. Cables concealed within trunking and conduits, or cables and conduits con-cealed under floors, in inaccessible roof spaces and generally within the fabric of the building or underground, have not been visually inspected.

E. DECLARATIONWle,being the person(s)responsiblefor the inspeefion andtesting of the electrical installation (as indicated bymy/our signaturesbelow), particulars of which are described above (see C), havingexercised reasonableskill and care when carrying out the inspection and te~ng, hereby declare that the informa~onin this report. including the observations [see F) and the attached schedules(see HI, providesan accurate assessmentof the condition of the electrical instaUatiootaking into account the stated extentof the installation andthe limitationsof the inspectionand testing (see 0),I/We further declare that in my/our judgement. the said installation was overall in"$ \ _ t condition (see G) al the time the inspectionwas carried out and that it should be further inspected as recommended (see I). .. Q.~\ ~rctc,k:;"o r,--\

(Insert 'a satisfactory' or 'an unsmisfBctory: as appropriate)

G AND ASSESSMENT BY: REPORT REVIEWED AND CONFIRMED BY: t See note below

Signature:

Name:(CAPITALS)

Name:(CAPITALS)

Position:

Date:Date:

Page 1 of rnt The completed report should preferably be reviewed by another competent person to confirm that the declared overall condition of the electrical installationIS consistent with the inspection and test results, and with the observations and recommendations for action (if anyl made in the report

This form is based on the model shown in Appendix 6 of BS 7671: 2001Published by the National Inspection Council for Electrical Installation Contracting © Copyright NICEIC (Nov 2002)for use by electrical contractors not enrolled with the NICEIC and for NICEIC Approved Contractors working outsidethe scope of their enrolment. Please see the 'Noles for Recipients'

on the reverse 01 this page.

caCeft~o

F. OBSERVATIONS AND RECOMMENDATIONS FOR ACTIONS TO BE TAKENReferring to the attached schedules of inspection and test results, and subject to thvunitations at 0:

There are no items adversely .affecting electrical safety. Vor

The followinq observations and recommendations are made.Code tItem Ne

1.1

II!~

::

J

II"!

:1II ~~u t:ft'I I

RB

Nota: If I>BCessary;continue on'Bddiri(Jna/ pages(s}, which must fle id~mified l1ytM Periodic Inspection ".porr date'Bnd pagl! number(s}.

t Where observations are made, the Inspector wifJ have entered one of the following codes against each observation to indicate the action (if any) recommended:I. 'requires urgent attention' Dr 2. 'requires improvement' or3. 'requires further investigation' or f. 'does Dot complv with BS 7677: 2001'

Please see the reverse of this page for guidance regarding the recommendations.

Urgent remedial work recommended for Items: Corrective action(s) recommended for Items;

G. SUMMARY OF THE INSPECTIONGeneral condition of the installation:

-r\-..Q_ \ (\~~o...LL oJ=, 0 (\,

Note: If necessary; continue on additional pagels), which must be identified by the Periodic Inspection "eport date and page numbetis).

Date(s) ofthe inspection: ~,. ~C)\.) \ 1- ~fth:~n~~~Ii~ti~::nt So,_\c:-\ s, ~c?'("-i~(Entry should read either 'Satisfactory' or 'Unsatisfactory?

Page20f ~

This form is based on the model shown in Appendix 6 of BS 7671: 2001Published by the National Inspection Council for Electrical Installation Contracting © Copyright NICEIC (Nov 2002)for use by electrical contractors not enrolled with the NICEIC and for NICEIC Approved Contractors workingoutside the scope of their enrolment.

Please see the 'Guidance forRecipients on the RecommendationCodes' on the reverse of this page.

GPf2F

CISCC).;::o

Schedule of Items Inspected and Schedules of Items Tested: Page No 4 Additional pages, including additionalsourcels) data sheets; Page No(s)

H. SCHEDULES AND ADDITIONAL PAGES

Schedule of CirGuit Details for the Installation: Page Nols) 5 Schedule ,of Test Results for the Installation: Page No(s) 6

The pages identified flere form an essential part of this report The report is valid only if accompanied by all the schedules and additional pages identified above.

lEnter interval in terms of wars, months or weeks, 85appropriaC8/

I. NEXT INSPECTIONINVe recommend that this installation is further inspected and tested after an interval of not more than

provided that any items at F which have been attributed a Recommendation Code 1 (requires urgent attention) are remedied withoutdelay. Items which have been attributed a Recommendation Code 2 or 3 should be actioned as soon as practicable (see F).

J. DETAilS OF ElECTRICAL CONTRACTOR

Address:

C_J Q:;\..a_c..tA"L.C cJ2'J_$( CCO-V\ bCN ~'t"O.. <+JQ_'(\A.eJZ)~

\-l~f(J.

Telephone number: OI'S\.

Fax number:

Trading Title:

-Postcode:c.~'1I~

3-phase(4w!ret other

Nomina) 50 Hz Notes: BS{EN) t -:SO \frequency, t"(I) wenquilY

Prospective tault 11- kA (2) byenquiJyor by Type \ ~currant, Ipi~! • measurement ~j Extemalearthfault {3) where more than Nominal current

~O AjlooPlmpedance.z.13X41 0 .O~ Q one supply, f8ClJrti rating

th. high.rorNumber of \

highestvaTuBs Short-circult 6~ kAsupplies (4) bymeas~rement capacity

ol> System Type(s):

TN-S

.:-NumberandTypeof LiveConductors

a.c, ~ d.c.

lick boxes.snd. enter details, 8S appropriate

Nature of Supply Parameters + Characteristics of Primary SupplyNominal UI1! '1"2 _ V U /II I'} ., V Overcurrent Protective Device(s)

voltage{s): cs-» .~-O

TT

v'!1.phase1 (2w!re)

i2·phas~t (,wireli 3>phase

1130

::

_-l.phase."...,-- 13wlrel

2pole

3·pole

Please stateIT

l. PARTICULARS OF INSTAllATION AT THE ORIGIN+Means of Earthing :Supplier's ! Type:tacillty: ."...-! leg rod{s),tapeetc)

Tick boxes and enter details, 8S appropriate

Details of Installation Earth Electrode (where applicable)

~AInstallation 1\ I i Electrode (Q) Method ofearth electrode: IN'"' j resistance, RJ\: ~A- measurement N f\......._.___.__._-_:.___ - -..- -..- -~,-..- ..-..---.--.-~-.-.-.-- --- - ~.._ ..--.-..._-_..____..-._-====

·z·Main Switch or Circuit-Breakilr iMaximum A per j Method of ProtectIon A A. S{8ppffcabl8onlywflere8nRCO/$suitBblealldisU$1dIlS8tT18incircuit·bre8~rljDemarnl (Load}: .4S phase + againstlndirect Contact • V'Type: . Voltage ~-r····-·····-·-·-··----··--·""-~·~-MainProtedi;,e~ConiiUct;s-·~-~-~~··'---·~·---· -~--~-BS(ENj (0\ 00 ~ fating ~O V : Earthing conductor ; Main BquipolBntial bonding conductors! Bonding of exlraneous-conductive·parts (.r)

No of current! Conduqor r- _[\n J I Conductor r"'_ fV\ J I Water Gas servicePoles ~O rating, In \oo A ! matenal '-0"1" "'-V\'-_ material \",..Q¥\'Ol.- service __

~,.- ......DO-.D RCDoperating • .2>..9~A t Conductor \ I _ mm' !... Condll~~~ \ 0 mm- :,. servi~~materiel 'I...LJ"{,"~" currentliln'~" f csa 'C)

Sc,uppL 11 c+ a rnm' RCDoperating;..". 0 ms! Continuity .-.-I ..r) .,',',Continu"" check .-t.r) ! LightningC:W"~.. 1-...::::. • time (at It.n)·' I. -, i check ~ , "7 .......... \ Iprotection

Location:

Structuralsteel

Other incomingserviceisl

.;. VVhere a number of sources are available to supply the installation and where the data given for the primary source may differ fromother sources, a separate sheet must be provided which identifies the relevant information relating to each additional source.

Page30f rnThis form is based on the model shown in Appendix 6 of BS 7671: 2001Published by the National Inspection Council for Electrical Installation Contracting © Copyright NICEIC (Nov 2.002)for use by electrical contractors not enrolled with the NICEIC and for NICEIC Approved Contractors working outsidethe scope of their enrolment. Please see the 'Notes for Recipients'

on the reverse of this page.GP/3F

SCHEDULE OF ITEMS INSPECTED t See note below

Methods of protection against electric shock

a. Protection against both direct and indirect contact

(i) SElV

~ l\- (ii) limitation of discharge of energy

b. Protection against direct contact

,.".-- (i) Insulation of live parts

.,..,.--Oi) Barriers or enclosures

~ Pr (iii) Obstacles

~ (iv) Placing out of reach

\..l p.; (v) PElV

~ (vi) Presence of RCD for supplementary protection

c. Protection against indirect contact

(i) EEBAD including:

~ Presence of earthing conductor

Prevention of mutual detrimental influence/ a. Pwximity of non-electrical services and other influences

t. \ ~ b. Segrellation of Band I and Band II circuits or Band II.... f"T insulation used

Nrr- c. Segregation of safety circuits

Identification

_...f>resence ot diagrams, instructions, circuit charts and~ similar information

/ Presence of danger notices and other warning notices

./ labelling of protective devices, switches and terminals

\/'" Identification of conductors

Cables and Conductors

~outinQ of cables in prescribed zones or within mechanical~ ~ectlon

_"""'Connection of conductors

..............Erection methods

~Selection of conductors for current carrying capacity andvoltaqs drop

L, 1\ Presence offire barriers, suitable seals and protection against...." ,...... thermal effects

Presence of circuit protective conductors

Presence of main equipotential bonding conductors

Presence of supplementary equipotential bondingconductors

Presence of earthing_arrangements for combinedprotective andluncnonal purposesPresence of adequate arrangements for alternativesource(s), where applicable

Presence of residual current device(s)

General~esence and correct location of appropriate devices for

isolation and switching

/ Adequacy of access to switchgear and other equipment

Nf.\ Particular protective measures for special installations and locations

_....tonnection of single-pole devices for protection or~ switching in phase conductors only

~ Correct connection of accessories and equipment

h.) f'; Presence of undervoltage protective devices

_.....-choice and setting of protective and monitoring devicesyr (fOF protection against indirect contact and/or overcurrent)~election of equipment and protective measures

appropriate to external influences

/seleCtion of appropriate functional switching devices

'--protection by separation of circuits

~ Protection against direct contact by barrier or enclosure~ provided during erection

...,........,Insulation of non-conducting floors or walls

--Polarity

.......-Earth fault loop impedance, Is"""-Operation of residual current devices

v"Functional testing of assemblies

SCHEDULE OF ITEMS TESTED

v" Oi) Use of Class Il equipment or equivalent insulation

,. \ rx: (iiil Non-conducting location:~ ,..... Absence of protective conductors

(iv) Earth-free equipotential bonding:Presence of earth-free equipotential bonding conductors

(v] Electrical separation

+ See note below

~emal earth fault loop impedance, Z.

H

'Ii

~~£~ r,('

-g:;;c.

£~cacC)

-.::0

Installation earth electrode resistance, RA

~ontinuity of protective conductors

/"" Continuity of ring final circuit conductors

.,/ Insulation resistance between live conductors

/ Insulation resistance between live conductors and earth

"l(\ Site applied insulation

t All boxes must be completed.V' indicates that an inspection or a test was carried out and that the result was satisfactory')C' indicates that an inspection or a test was carried out and that the result was unsatisfactory

'N/A' indicates that an inspection or a test was not applicable to the particular installation

'LIM' indicates that exceptionally, a limitation agreed with the person ordering the work

(as recorded in Section Dj prevented the inspection or test being carried outPage40f L1f

This form is based on the model shown in Appendix 6 of BS 7671: 2001Published by the National Inspection Council for Electrical Installation Contracting © Copyright NICEIC (Nov 2002) for use byelectrical contractors not enrolled with the NICEIC and for NICEIC Approved Contractors working outside the scope of their enrolment.

GP 14F

SCHEDULE OF CIRCUIT DETAILSFOR THE INSTALLATION

TO 8E COMPlETED l.N EVERY CASE ONLYTO BE COMl'tETEIllf THE DISTRIBUTION BOARD IS NDT CONNECml DIRECTlY TO THE ORIGIN OF THE INSTAUAllOIr

location of .-.10 _,! SupplytodiStributionj I Noot lNominal ~ 1>,distribution board: rr-e,,'c. U\ I~ board is from: I phases: voltage: .'

j Associ<lted~_ _ Overcurrent protective device for the distribution cireuit: Reb (Wanyf:BSlEN)

Ofstripution I Type; . RCONO·'----t--.~""""--Irboard designation: 'D P::::. 'BS(EN) Rating: A of Pble~~ I~ ~

E.~~~~:i;~:&W~~~~~~\)-~~::tHII:{MIJIrUJ:"!'I"'~j CircUit designation. 01I t r "n""~~;"~~:csa OverCUll'ent protective deviees RCO ~

~~ !fl~ 11 ~ liVe cpc !t~ IlS(EN) ',~ ~~~.lS t~H ~jlfhd'mm' 1m., 1~ ii i U ~JU'I L-\~h.~ un A \ 1\\0 1\ .0 '\.0 .4- \o~9<l' !~ \0 ~ I~\:) Ib.4-

\..~~~~

•\ \"'b~G~ !B'2. ~~t'\ A- \' Ie \ .0 ,'4- \0 b I~o 11q·\...t

"3 ~~c.M'e-r; uD IA- \ \0 I/L~ ,.S- .\w b~","o..~ R "1...7 \0 ~~ 1\·404-

U. ~r.r...<~ /)r-..L~(\ IA- " l\lL !L.S" L"'S'" .~ ,,",~<i..q ~ 'R ~'2. b :~c 1'.4-4

s- Cnr-,....x-c..-l. .I\- \ \ leo·o 2S .~ b~~q~ & ~"2.. (0 ~o 11·4-4

ta ~"'o~ct C+- \ \ 110.0 1'2...~ .l.... ~~C\K R. 'K"2.. b ~D 1\ .w..

t See Table 4A1 of Appendix 4 of 8S 7671: 2001

CODES FOR TYPE OF WIRINGA B C D E F G H o (Other· please state)

PVC/PVC PVCcables PVCcables PVCcables PVCcables PVC/SWA XLPE/SWA Mineral·cables in metallic in non·metallic in metallic in non-metallic cables cables insulated

conduit conduit trunking trunking cablesPage 5 of [3J

GP/SF

* In such cases, details of the distribution (sub-main) circuit(s), together with the test results for the circuit(s), must also be provided.

This form is based on the mode} shown in Appendix 6 of BS 7671: 2001Published by the National Inspection Council for Electrical Installation Contracting © Copyright NICEIC (Nov 2002) for useby electrical contractors not enrolled with the NICE}C and for NICEIC Approved Contractors working outside the scope oftheir enrolment

See next page forSchedule of Test Results

See reve rse of page 1 for explanatory notes relating to NICEICsoftware endorsement

ONLYTO BE COMPlETED IF THE OIS11lll!UTIOI1I BOARD IS NOT CONNECTED Test instruments (serial numbers) used:- IIIIIEtTl.Y TOTHE OIIIGIN OF THE INSTAllATION

Earth fault loop J"* S•• fIfl!SbO'O>t Charaj:18ristic$ at Ibis 8i.stributiD~board o Li. ..", -~'"RCDimpedance - ,I -

Z. I" Q. Operating times AtlMI ~msInsulation 1 Other I ~resistance - \ \ - ~A

'Ii of assoctatadIPf ~ RCO (if any) At51M L, jn: Continuity Other I N1" Ilil~r s - \\ - ~

-:~ml.·illu.'1 .~~I~~-q::'~t}:J~~iI~fil~~..; ,

Circuit impedances,~ ""!'"""" - •• '~' ,~. :...:;; ......Jor~~, _~ .~._

~ ~~s::~i:f;alu.8 Polari~ .. RCD operatingE~ - (Q) t ReG{Jrd IqW8f_D( Imeasur~ Barth times"",

,Ring fina:dc!;:tr: on~ AII'Circoits I'llase/Phase t .- Phase~arth't :~ .C faukloop,C-E_ ,"."..,,"""'.. impeQance.z. ailM at SiAn;t:::."O I to en I (At l(!ast onHolul!IO_.e ~

(P:~se) (cicl

IllbecQII1pletedl - I'll" ,-~ Iff applicable)U r. ""(jl(Neutral) R, +:R2 R2 {Mm {Mal {MQI {MQI (Q) {msl (ms)

\ - ~A .~(g "-lA- ~C+ f)_c~q( .v--10.6'1 Ir1.C\ -.. \

'2- ~A- .b<fi" t\lA- NA- '10lC\+ V--10· ,-" n.q 11 \- -~ .1(0 ..\\0 \.,s- ~"1 \ ~A- ~A- f)c rO(-t v- IC·bS n.~ ..,. (

u. .. iol.4- • l:. '+ !\ ·6<6 .b\ Nt+- ~A i)C ~a-~ ~ 1C'l.t,, ,.,.<=t 1.\s- - h..)A- - 1-'61.. "'-lA- ~A I]c r'"1+ ~ lo~ \.-'.~ 1'1 \l.o -~.:!Pr- - 1~'1.6~A ~A. /)r ....,.-, ~ b·S1. r..,·~ 'I. \

!

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SCHEDULE OF TEST RESULTSFOR THE INSTALLATION

=s::::0)'i:o

" Note: Where the Instal/allan can be supplied by more than one source, such 8S a pnmary source (eg public supply) and a secondary source (eg standby generator), the higher or highestvalues mu ded"

TESTED BY

Signatur-e:

Name:(CAPITAlS)

Date oftesting:

GP/6F

This form is based on odel shown in Appendix 6 of BS 7671: 2001Published by the National Inspection Council for Electrical Installation Contracting © Copyright NICEIC (Nov 2002) for use byelectrical contractors not enrolled with the NICEIC and for NICEIC Approved Contractors working outside the scope of theirenrolment

See previous page forSchedule of Circuit Details