Company: Control Sheet Number:

Address: Inspector:
Results Log Sheet Test Date:

Re-test Date:

(4)
1 2 3 AS REQUIRED
5
REMEDIAL

DESIGNED FOR
DOMESTIC USE
APPLIANCE FUSE WORK VISUAL EARTH INSULATION POLARITY CURRENT FUNCTION OVERALL
APPLIANCE APPLIANCE DESCRIPTION
CLASS SIZE RESULT CONTINUITY RESISTANCE TEST LEAKAGE* CHECK RESULT
LOG No.

ONLY**
DATE UNIQUE

NEW PLUG
NEW FUSE

REPAIR
NUMBER

FITTED

FITTED
LEADS &
CLASS I CLASS I & II CLASS I & II
EXTENSIONS ALL
(MAKE, MODEL & SERIAL NUMBER)
NOT EQUIPMENT
I II A (CIRCLE) Ω M Ω mA (CIRCLE)
APPLIANCES

1 PASS FAIL PASS FAIL PASS FAIL PASS FAIL

2 PASS FAIL PASS FAIL PASS FAIL PASS FAIL

3 PASS FAIL PASS FAIL PASS FAIL PASS FAIL

4 PASS FAIL PASS FAIL PASS FAIL PASS FAIL

5 PASS FAIL PASS FAIL PASS FAIL PASS FAIL

6 PASS FAIL PASS FAIL PASS FAIL PASS FAIL

7 PASS FAIL PASS FAIL PASS FAIL PASS FAIL

8 PASS FAIL PASS FAIL PASS FAIL PASS FAIL

9 PASS FAIL PASS FAIL PASS FAIL PASS FAIL

10 PASS FAIL PASS FAIL PASS FAIL PASS FAIL

11 PASS FAIL PASS FAIL PASS FAIL PASS FAIL

12 PASS FAIL PASS FAIL PASS FAIL PASS FAIL

13 PASS FAIL PASS FAIL PASS FAIL PASS FAIL

14 PASS FAIL PASS FAIL PASS FAIL PASS FAIL

15 PASS FAIL PASS FAIL PASS FAIL PASS FAIL

16 PASS FAIL PASS FAIL PASS FAIL PASS FAIL

17 PASS FAIL PASS FAIL PASS FAIL PASS FAIL

18 PASS FAIL PASS FAIL PASS FAIL PASS FAIL

19 PASS FAIL PASS FAIL PASS FAIL PASS FAIL

20 PASS FAIL PASS FAIL PASS FAIL PASS FAIL

(4) * As required if Insulation Resistance Test result is suspect - Leakage Current Test / Substitute Leakage Test / Touch Current Test

** Carry out a Risk Assessment to decide appliance suitability RESULTS LOG SHEET v4.08.01 Additional copies available at www.priorytrainingacademy.co.uk
FAILED APPLIANCES

APPLIANCE APPLIANCE DESCRIPTION VISUAL RESULT TEST RESULT REASON FOR FAIL ACTION TAKEN
LOG No.

UNIQUE
NUMBER

(CIRCLE) (CIRCLE)

1 PASS FAIL PASS FAIL

2 PASS FAIL PASS FAIL

3 PASS FAIL PASS FAIL

4 PASS FAIL PASS FAIL

5 PASS FAIL PASS FAIL

6 PASS FAIL PASS FAIL

7 PASS FAIL PASS FAIL

8 PASS FAIL PASS FAIL

9 PASS FAIL PASS FAIL

10 PASS FAIL PASS FAIL

REPAIRS, NOTES & OBSERVATIONS