ELECTRICAL INSTALLATION CERTIFICATE Certificate Reference:

Issued in accordance with British Standard BS 7671 0039291

Requirements for Electrical Installations

1. DETAILS OF THE CLIENT

Client Address: Sample Client 1, Address Line 1, Address Line 2, Address Line 3, POSTCODE
2. DETAILS OF THE INSTALLATION The installation is:
Installation Same as Client Address New N/A
Address:
Extent of the Fire alarm not tested. An addition N/A
installation covered
by this certificate: An alteration

3. DESIGN
I/We, being the person(s) responsible for the design of the electrical installation (as indicated by my/our signature(s) below)
particulars of which are described above, having exercised reasonable skill and care when carrying out the design, hereby CERTIFY
that the design work for which I/we have been responsible is, to the best of my/our knowledge and belief,
in accordance with BS 7671: amended to N/A except for the departures, detailed as follows:
Details of departures from BS 7671, as amended (Regulations 120.3, 120.4): None
The extent of liability of the signatory/signatories is limited to the work described above as the subject of this certificate.
For the DESIGN of the installation:
Name: JOE ENGINEER Position: Electrician Signature: Date: 03/11/2005
Where there is divided responsibility for the design
Name: JOE ENGINEER Position: Electrician Signature: Date: 03/11/2005
4. CONSTRUCTION
I/We, being the person(s) responsible for the construction of the electrical installation (as indicated by my/our signature(s) below)
particulars of which are described above, having 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 BS 7671: amended to N/A except for the
departures, if any, detailed as follows:
Details of departures from BS 7671, as amended (Regulations 120.3, 120.4): None
The extent of liability of the signatory/signatories is limited to the work described above as the subject of this certificate.
For the CONSTRUCTION of the installation:
Name: JOE ENGINEER Position: Electrician Signature: Date: 03/11/2005
5. INSPECTION AND TESTING
I/We, being the person(s) responsible for the inspection and testing of the electrical installation (as indicated by my/our
signature(s) below) particulars of which are described above, having exercised reasonable skill and care when carrying out the
inspection and 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 BS 7671: amended to N/A except for the
departures, if any, detailed as follows:
Details of departures from BS 7671, as amended (Regulations 120.3, 120.4): None
The extent of liability of the signatory/signatories is limited to the work described above as the subject of this certificate.
For the INSPECTION AND TESTING of the installation:
Name: JOE ENGINEER Position: Electrician Signature: Date: 03/11/2005
The Inspection and Testing results reviewed by the Qualified Supervisor:
Name: JOE ENGINEER Position: Electrician Signature: Date: 03/11/2005
6. DESIGN, CONSTRUCTION, INSPECTION AND TESTING
I/We, being the person(s) responsible for the design, construction, inspection and testing of the electrical installation (as indicated
by my/our signature(s) below) particulars of which are described above, having exercised reasonable skill and care when carrying
out the design, construction, inspection and testing, 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 BS 7671: amended to
N/A except for the departures, if any, detailed as follows:

Details of departures from BS 7671, as amended (Regulations 120.3, 120.4): None

The extent of liability of the signatory/signatories is limited to the work described above as the subject of this certificate.
For the DESIGN, the CONSTRUCTION, and the INSPECTION AND TESTING of the installation:
Name: JOE ENGINEER Position: Electrician Signature: Date: 03/11/2005
The Design, Construction, Inspection And Testing results reviewed by the Qualified Supervisor:
Name: JOE ENGINEER Position: Electrician Signature: Date: 03/11/2005
This form is based on the model shown in Appendix 6 of BS 7671:2008 Page: 1 of 5
7. DETAILS OF THE ELECTRICAL CONTRACTOR
DESIGN (1) Trading Title: ELECTRICAL SAFETY SYSTEMS LIMITED
Address: Fulwood Road North Registration Number: 024428 / 01623 4600
Sutton in Ashfield
Nottinghamshire Telephone Number: 01623 460018
Postcode: NG17 2NB

DESIGN (2) Trading Title: Same as Above

Address:
Registration Number:

Telephone Number:
Postcode:

CONSTRUCTION Trading Title: Same as Above

Address:
Registration Number:

Telephone Number:

Postcode:
INSPECTION
AND TESTING Trading Title: Same as Above
Address:
Registration Number:

Telephone Number:

Postcode:

8. SUPPLY CHARACTERISTICS AND EARTHING ARRANGEMENTS

System Type(s) Number and Type of Live Conductors Nature of Supply Parameters Characteristics of Primary
Supply Overcurrent
Nominal
TN-S
 1-phase
ac:

1-phase
dc: N/A voltage(s):
U: 230 V Uo: 238 V Protective Device(s)

Nominal frequency, f:
TN-C-S N/A (2 wire):
2-phase
 (3 wire): N/A 2 pole: N/A
Prospective fault
50 Hz BS(EN): 1361
TNC N/A (3 wire): N/A 3 pole: N/A current, lpf: 1.28 kA Type: 2
3-phase 3-phase External earth fault
TT N/A (3 wire): N/A (4 wire): N/A Other: N/A 0.17  Rated current: 60 A
loop impedance, Ze:
Short-circuit
IT N/A Other: N/A Number of supplies: 1 capacity: 33 kA

9. PARTICULARS OF INSTALLATION AT THE ORIGIN

Means of Earthing Details of Installation Earth Electrode (where applicable)
Distributor's
facility:  Type: N/A Location: N/A
Installation Electrode Method of
earth electrode: N/A resistance, RA: N/A  measurement: N/A

Maximum Demand (Load): 60 Amps Protective measure(s) against electric shock: ADS
Main Switch or Circuit-Breaker Earthing and Protective Bonding Conductors
Type Earthing conductor
BS(EN): 60947-2 MCCB Voltage rating: 400 V Conductor Conductor Continuity
Number of Rated material: Copper csa: 16 mm2
check: 
poles: 2 current, ln: 125 A Main protective bonding conductors
Supply Conductor Conductor Continuity
conductors Copper
RCD operating
N/A mA
material: Copper csa: 10 mm2 check: 
current: Bonding of extraneous-conductive parts
material:
Lightning
Supply
conductors 25
RCD operating
mm2 time: N/A ms
Water service:  Oil service:  protection:
N/A
csa: Gas service: N/A Structural Steel: N/A Other services: N/A
10. COMMENTS ON EXISTING INSTALLATION
Note: Enter 'NONE' or, where appropriate, the page number(s) of additional page(s) of comments on the
existing installation. None
11. NEXT INSPECTION
I/We, the designer(s), RECOMMEND that this installation is further inspected and tested after an
interval of not more than: 5 Years
This form is based on the model shown in Appendix 6 of BS 7671:2008 Reference: 0039291 Page: 2 of 5
12. SCHEDULE OF ITEMS INSPECTED Prevention of mutual detrimental influence
Methods of protection against electric shock N/A (a) Proximity of non-electrical services and other
influences
Basic and fault protection:
N/A (b) Segregation of Band I and Band II circuits or use of
Band II insulation
N/A (i) SELV N/A (ii) PELV

Double or reinforced insulation:

 (c) Segregation of safety circuits
Identification
Presence of diagrams, instructions, circuit charts and
 (iii) Double or Reinforced Insulation
 similar information
Basic protection:
(i) Insulation of (ii) Barriers or  Presence of danger notices and other warning notices
 live parts
N/A enclosures Labelling of protective devices, switches and terminals
N/A (iii) Obstacles ** N/A (iv) Placing out 
of reach **
Fault protection:  Identification of conductors
Cables and Conductors
(i) Automatic disconnection of supply Selection of conductors for current carrying capacity and
 voltage drop
 Presence of earthing conductor
 Erection methods
 Presence of circuit protective conductors
Routing of cables in prescribed zones or within
 mechanical protection
 Presence of main protective bonding conductors
Cables incorporating earthed armour or sheath, or run
Presence of earthing arrangements for combined N/A
 protective and functional purposes
within an earthed wiring system, or otherwise adequately
protected against nails, screws and the like
Presence of adequate arrangements for alternative
 source(s), where applicable
Additional protection provided by 30mA RCD for cables in
N/A FELV  concealed walls (where required in premises not under
the supervision of skilled or instructed persons)
N/A Choice and setting of protective and monitoring devices
(for fault protection and/or overcurrent protection)
 Connection of conductors

(ii) Non-conducting location ** Presence of fire barriers, suitable seals and protection
N/A against thermal effects
 Absence of protective conductors General
Presence and correct location of appropriate devices for
(iii) Earth-free local equipotential bonding **  isolation and switching
Adequacy of access to switchgear and other equipment
N/A Presence of earth-free local equipotential bonding 
(iv) Electrical Separation Particular protective measures for special installations
N/A and locations
N/A Provided for one item of current-using equipment Connection of single-pole devices for protection or
Provided for more than one item of current-using
 switching in line conductors only
 equipment ** N/A Correct connection of accessories and equipment
Additional protection:
N/A Presence of residual current device(s)  Presence of undervoltage protective devices
Selection of equipment and protective measures
N/A Presence of supplementary bonding conductors  appropriate to external influences

** For use in controlled supervised/conditions only N/A Selection of appropriate functional switching devices

13. SCHEDULE OF ITEMS TESTED Protection against direct contact by barrier or enclosure
N/A provided during erection
 External earth fault loop impedance, Ze
 Insulation of non-conducting floors or walls
N/A Installation earth electrode resistance, RA
N/A Polarity

 Continuity of protective conductors

 Earth fault loop impedance, Zs

 Continuity of ring final circuit conductors

 Verification of phase sequence

 Insulation resistance between live conductors

 Operation of residual current device(s)
Insulation resistance between live conductors and earth
  Functional testing of assemblies
N/A Protection by separation of circuits
 Verification of voltage drop

14. SCHEDULE OF ADDITIONAL RECORDS (See attached schedule)

Note: Additional page(s) must be identified by the Electrical
Installation Cert serial and page number(s). None
All boxes must be completed. 'tick' indicates that an inspection or test was carried out and that the result was satisfactory. 'X' indicates than an
inspection or test was carried out and the result is not satisfactory. 'N/A' indicates that an inspection or test was not applicable to the particular
installation. 'LIM' indicates that, exceptionally, a limitation agreed with the person ordering the work prevented the inspection or test being carried out.

This form is based on the model shown in Appendix 6 of BS 7671:2008 Reference: 0039291 Page: 3 of 5
 TO BE COMPLETED ONLY IF THE DISTRIBUTION BOARD IS NOT CONNECTED
TO BE COMPLETED IN EVERY CASE
DIRECTLY TO THE ORIGIN OF THE INSTALLATION
Location of distribution board: Supply to distribution No of Nominal
N/A phases: N/A Voltage: N/A V
Dining Room Cupboard board is from:
Overcurrent protective device for the Associated RCD
distribution circuit: (if any) BS(EN): N/A
Distribution board designation:
Type RCD No
D.B. 1 BS(EN): N/A Rating: N/A A of poles: N/A RCD ln: N/A mA

15. CIRCUIT DETAILS

Circuit

permitted by BS7671

permitted by BS7671
Overcurrent protective

Max disconnect time

conductors: RCD
devices
csa

Reference Method

Maximum Zs
Short-circuit
Circuit number

Type of wiring

points served
Circuit designation

Operating
Capacity
Type No
Number of
and phase

current
Live cpc BS(EN)

Rating
mm2 mm2 s A kA mA 
1 Ground Floor Lights A 1 --- 1 1 5 60898 B 6 6 --- ---
2 1st Floor Lights A 1 --- 1 1 5 60898 B 6 6 --- ---
3 2nd Floor Lights A 1 --- 1 1 5 60898 B 6 6 --- ---
4 Fire Alarm A 1 --- 1.5 1 5 60898 B 16 6 --- ---
5 Old Immersion A 1 --- 2.5 1 5 60898 B 16 6 --- ---
6 1st and Ground Floor Sockets A 1 --- 2.5 1 0.4 60898 B 32 6 20 10
7 Kitchen Sockets A 1 --- 2.5 1 0.4 60898 B 16 6 19 9
8 2nd Floor Sockets A 1 --- 2.5 1 0.4 60898 B 32 6 18 9

16. CODES FOR TYPE OF WIRING

A: PVC/PVC cables D: PVC cables in metallic trunking G: XLPE/SWA cables
B: PVC cables in metallic conduit E: PVC cables in non-metallic trunking H: Mineral-insulated cables
C: PVC cables in non-metallic conduit F: PVC/SWA cables O - Other:

This form is based on the model shown in Appendix 6 of BS 7671:2008 Reference: 0039291 Page: 4 of 5
17. CHARACTERISTICS AT THIS D.B. 18. DETAILS OF TEST INSTRUMENTS
TO BE COMPLETED ONLY IF THE DISTRIBUTION BOARD IS NOT Test Instruments (serial numbers) used:
CONNECTED DIRECTLY TO THE ORIGIN OF THE INSTALLATION Earth fault loop
7654321 RCD: 1234567
 Confirmation of supply polarity impedance:
Insulation
Zs: N/A  Operating times At ln: N/A ms Resistance: 1234567 Other: N/A
of associated RCD
lpf: N/A kA (if any) At 5ln: N/A ms Continuity: 1234567 Other: N/A
19. TEST RESULTS
Insulation resistance RCD Operating
Circuit impedances (Ohms) Maximum
(record lower or lowest value) times
measured
All circuits earth fault
Ring final circuits only
Circuit number

(one column to be Polarity loop

(measured end to end)
completed) Line/ Line/ Line/ Neutral/ impedance
and phase

Line Neutral Earth Earth At ln At 5 ln

Zs
r1 rn r2 R1+R2 R2
(Line) (Neutral) (cpc) M M M M   ms ms
1 --- --- --- 1.00 --- N/A > 200 > 200 > 200  0.76 --- ---
2 --- --- --- 1.20 --- N/A > 200 > 200 > 200  0.88 --- ---
3 --- --- --- 1.60 --- N/A > 200 > 200 > 200  0.99 --- ---
4 --- --- --- 1.18 --- N/A > 200 > 200 > 200  0.29 --- ---
5 --- --- --- 1.00 --- N/A > 200 > 200 > 200  --- --- ---
6 0.43 0.44 1.43 --- --- N/A > 200 > 200 > 200  0.90 18 9
7 --- --- --- 0.25 --- N/A > 200 > 200 > 200  0.41 --- ---
8 0.63 0.62 1.36 --- --- N/A > 200 > 200 > 200  0.87 19 9

20. TESTED BY
Name: JOE ENGINEER Position: Electrician
Date of
Signature: 01/11/2005
testing:

This form is based on the model shown in Appendix 6 of BS 7671:2008 Reference: 0039291 Page: 5 of 5
 ELECTRICAL INSTALLATION CERTIFICATE

GUIDANCE FOR RECIPIENT (to be appended to the Certificate)

This safety Certificate has been issued to confirm that the electrical installation work to which it
relates has been designed, constructed and inspected and tested in accordance with British Standard
7671 (as amended) (The IEE Wiring Regulations).

You should have received an original Certificate and the contractor should have retained a duplicate
Certificate. If you were the person ordering the work, but not the user of the installation, you should
pass this Certificate, or a full copy of it including the schedules, immediately to the user.

The 'original' Certificate should be retained in a safe place and be shown to any person inspecting or
undertaking further work on the electrical installation in the future. If you later vacate the property,
this Certificate will demonstrate to the new owner that the electrical installation complied with the
requirements of British Standard 7671 at the time the certificate was issued. The Construction
(Design and Management) Regulations require that for a project covered by those regulations, a copy
of this Certificate, together with schedules is included in the project health and safety documentation.

For safety reasons, the electrical installation will need to be inspected at appropriate intervals by a
competent person. The maximum time interval recommended before the next inspection it stated on
Page 1 under 'Next Inspection'.

This Certificate is intended to be issued only for a new electrical installation or new new work
associated with an alteration or addition to an existing installation. It should not have been issued for
the inspection of an existing electrical installation. A 'Periodic Inspection Report' should be issued for
such a periodic inspection.

This Certificate is only valid if a Schedule of Inspections and Schedule of Test Results are appended.