Test Record Form

* Job #

* Customer

* Date

* Site Address

* Description of Works

Test Results

	Type	# of Points	Visual	Protection (Amps)	Cable Size	Cont (Ohms)	Resistance (Mohms)	Polarity	Fault Loop	Operational
Circuit
Circuit
Circuit
Circuit
Circuit
Circuit
Circuit
Circuit
Circuit
Circuit
Circuit
Circuit

TV, Data, Phone & Foxtel Points

	# of Points	Labeled	Tested
Phone Points
TV Points
Data Points
Foxtel Points

Notes -

I certify that the electrical installation, to the extent that it is effected by the electrical work, has been tested to ensure its electrically safe and is in accordance with the requirements of the wiring rules and any other standard applying to the electrical installation under state legislation.

* Tested By

* Lic #

* Date of Test

* Indicates Response Required