Fillable Electrical Safety Check Report (Department of Infrastructure, Transport, Cities and Regional Development)

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Electrical Safety Check Report (Department of Infrastructure, Transport, Cities and Regional Development)

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Energy Safe Victoria - Residential Tenancies Regulations 2021 - Electrical Safety Check – Report
ESV-RTR –ESC 01.1 (April 2021) Page 1 o
f 2
Residential Tenancies Regulations 2021
Electrical Safety Check – Report
This electrical safety check is for electrical safety purposes only and is in accordance with the requirements of the Residential Tenancies
Regulations 2021 and is prepared in accordance with section 2 of the Australian/New Zealand Standard AS/NZS 3019, Electrical installations—
Periodic verification to confirm that the installation is not damaged or has not deteriorated so as to impair electrical safety; and to identify
installation defects and departures from the requirements that may give rise to danger.
A. INSTALLATION ADDRESS
Address:
Date of previous Safety Check: (if any)
C. SAFETY CHECK - VERIFIED BY VISUAL INSPECTION
As far as practicable a VISUAL INSPECTION of the following items has been carried out per the requirements of section 3 and 4 of the
Australian/New Zealand Standard AS/NZS 3019:2007 Electrical installations—Periodic Verification: strike out those parts of the installation if
not applicable – mark NI if not included in the safety check – add additional information if required.
Consumers mains
Space heaters
Switchboards
Cooking equipment
Exposed earth electrode
Dishwasher
Metallic water pipe bond
Exhaust fans
RCDs (Safety switches)
Celling fans
Circuit protection (circuit breakers / fuses)
Washing machine/dryer
Socket-outlets
Installation wiring
Light fittings
Solar and other renewable systems
Electric water heater
Swimming pool equipment
Air conditioners
Vehicle chargers
D. SAFETY CHECK - VERIFIED BY TESTING
As far as practicable TESTING of the following items has been carried out per the requirements of 4 of the Australian/New Zealand Standard
AS/NZS 3019:2007 Electrical installations—Periodic Verification: strike out those parts of the installation if not applicable – mark NI if not
included in the safety check – add additional information if required.
Polarity and correct connections testing
Consumers mains
Electric water heater
Circuit protection (circuit breakers / fuses)
Air conditioners
RCDs (Safety switches)
Cooking equipment
Socket-outlets
Dishwasher
Circuit protection (circuit breakers / fuses)
Solar and other renewable systems
Socket-outlets
Swimming pool equipment
Light fittings
Vehicle chargers
Earth continuity testing
Mains earth conductor
Electric water heater
Switchboards enclosure
Air conditioners
Metallic water pipe bond
Cooking equipment
Socket-outlets
Dishwasher
Light fittings
Solar and other renewable systems
Exhaust fans
Swimming pool equipment
Celling fans
Vehicle chargers
B. EXTENT OF THE INSTALLATION AND LIMITATIONS OF THE INSPECTION AND TESTING
Details of those parts of the installation and limitations of the safety check covered by this certificate Tick those parts of the installation included
in the safety check – strike out those parts of the installation if not applicable – mark NI if not included in the safety check – add additional
information if required.
Main switchboard
Other living areas
Main earthing system
Laundry
Kitchen
Garage
Bathroom (main)
Solar/battery system
Other bathrooms/ensuites
Electric water heater
Bedroom (main)
Dishwasher
Other bedrooms
Electric room/space heaters
Living room
Swimming pool equipment
Energy Safe Victoria - Residential Tenancies Regulations 2021 - Electrical Safety Check – Report
ESV-RTR –ESC 01.1 (April 2021) Page 2
of 2
D. SAFETY CHECK - VERIFIED BY TESTING - Continued
RCD (residual-current device /safety switch) testing
Circuit protected
Push button test (pass / fail)
Time test (pass / fail)
Power outlets
Power outlets
Power outlets
Lighting
Lighting
Other
E. Smoke Alarms
condition; and have been tested according to the
manufacturer's instructions.
Yes
No
Next smoke alarms check is
due by:
All smoke alarms must be tested according to the
manufacturer's instructions at least once every 12 months
F. OBSERVATIONS AND RECOMMENDATIONS FOR ANY ACTIONS TO BE TAKEN
The following observations and recommendations are made:
F. Electrical Safety Check Certification
Electrical Safety check
completed by:
Licence/ registration
number:
Inspection date:
Next inspection due
by:
I the above named licenced electrician have carried out an electrical safety check of this residential tenancies per the
requirements of the Residential Tenancies Regulations 2021 and set out in the Australian/New Zealand Standard
AS/NZS 3019, "Electrical installations—Periodic verification, and have recorded my observations and
recommendations. any)
Sign: Date:
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Electrical Safety Check Report (Department of Infrastructure, Transport, Cities and Regional Development)

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Completed 12 July 2021

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