Read PCN4 Certificate.qxd text version

PCN4/

FILLING STATION ELECTRICAL INSTALLATION COMPLETION CERTIFICATE

Issued by an Approved Contractor enrolled with NICEIC, Warwick House, Houghton Hall Park, Houghton Regis, Dunstable LU5 5ZX.

A DETAILS OF THE SITE OPERATOR

Name of site operator Address of filling station Telephone No Postcode Extent of Installation work

The installation work is New An addition An alteration

B 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 EN 60079 and BS 7671 amended to (date) and the recommendations given in the APEA/IP guide except for the departures, if any, detailed as follows:

D INSPECTION AND TESTING

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: **(Where there is divided responsibility for the design) Signature Signature

C CONSTRUCTION

I/We, being the person(s) responsible for the construction of the electrical installation (as indicated by my/our signature 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 EN 60079 and BS 7671 amended to (date) and the recommendations given in the APEA/IP guide except for the departures, if any, detailed as follows:

E P S

Date Date Name ( CAPITALS) Date Name ( CAPITALS)

Name ( CAPITALS)

M I C

Designer 1 ** Designer 2 Signature Constructor reviewed by Signature

I/We, being the person(s) responsible for the inspection and testing of the electrical installation (as indicated by my/our signatures 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 EN 60079 and BS 7671, amended to (date) and the recommendations given in the APEA/IP guide except for the departures, if any, detailed as follows:

The extent of liability of the signatory/signatories is limited to the work described above as the subject of this certificate.

N E

Name ( CAPITALS) Name ( CAPITALS)

For the INSPECTION AND TESTING of the installation: Signature Name Date ( CAPITALS) reviewed by Name Signature Date ( CAPITALS)

Inspector Qualified Supervisor

E DESIGN, CONSTRUCTION, INSPECTION AND TESTING *

* This box to be completed only where the design, construction, inspection and testing have been the responsibility of one person.

I, being the person responsible for the design, construction, inspection and testing of the electrical installation (as indicated by my signature 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 have been responsible is to the best of my knowledge and belief in accordance with BS EN 60079 and BS 7671, amended to (date) and the recommendations in the APEA/IP guide except for the departures, if any, detailed as follows: The extent of liability of the signatory 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. Date Date Inspector Qualified Supervisor Please see the `Notes for Recipients' on the reverse of this page. Page 1 of

PCN4/1

The extent of liability of the signatory is limited to the work described above as the subject of this certificate. For the CONSTRUCTION of the installation:

Signature

This form is based on the model given in Design, construction, modification, maintenance and decommissioning of filling stations, published by the Association for Petroleum and Explosives Administration (www.apea.org.uk) and the Energy Institute (www.energyinst.org.uk).

Published by NICEIC Group Limited © Copyright The Electrical Safety Council (Jan 2008) for use by NICEIC Approved Contractors enrolled with NICEIC and having an appropriate extension to enrolment for electrical work at filling stations.

Original

(To the person ordering the work)

This certificate is not valid if the serial number has been defaced or altered

NOTES FOR RECIPIENT

THIS CERTIFICATE IS A VALUABLE DOCUMENT WHICH SHOULD BE RETAINED FOR FUTURE REFERENCE

The `Original' certificate, together with other related reference documents identified in Section I, should be retained in a safe place and be shown to any person inspecting or undertaking further work on the electrical installation. If you later cease to be the operator of the site, the certificate will indicate to the new site operator the condition of the electrical installation at the time the certificate was issued. This certificate relates to the electrical installation, and to other electrical equipment, in and around the hazardous areas. Amongst others particulars, it records the details and test results of circuits supplying equipment in, and adjacent to, the hazardous areas which will be of interest to the Petroleum Enforcing Authority. It does not cover electrical installation circuits, associated switchgear and other equipment that do not encroach into the hazardous areas. These parts of the installation should be the subject of a separate Electrical Installation Certificate issued in accordance with the requirements of BS 7671 Requirements for Electrical Installations. Section A contains details of the site and the extent of the installation. The extent of the installation work should accurately describe the work to which this Electrical Installation Completion Certificate relates. During construction, an Inventory of Electrical Equipment should have been compiled and provided with the Electrical Installation Completion Certificate. If the work is an addition or an alteration to the existing electrical installation, the details of the addition or alteration should be recorded on the existing Inventory of Electrical Equipment. If such an inventory does not exist, then one should be compiled. There is a space for the recommended interval to the next inspection of the site. The recommended period for the inspection of Filling Stations is annually, unless there is a valid reason for an earlier inspection. The overall condition of the site will also be recorded in Appendix A as a "Certification Statement". This should always be `A' in a new installation. There should not be any deficiencies that relate to a failure to meet statutory requirements. If the "Certification Statement" is not an `A', the Contractor should be asked to remedy the deficiencies and issue another Electrical Installation Completion Certificate. Appendix A is intended for statutory enforcement purposes for petroleum licensing. It should be retained on site and be available for examination by a Petroleum Licensing Officer when demanded. Some Petroleum Licensing Officers may require the documents to be sent to them.

* NICEIC is a trading name of NICEIC Group Limited, a wholly owned subsidiary of The Electrical Safety Council. Under licence from The Electrical Safety Council, NICEIC acts as the electrical contracting industry's independent voluntary regulatory body for electrical installation safety matters throughout the UK, and maintains and publishes registers of electrical contractors that it has assessed against particular scheme requirements (including the technical standard of electrical work). NICEIC Approved Contractors, whose scope of enrolment includes electrical work at filling stations, have been assessed as having the technical capability to carry out electrical work in compliance both with British Standard 7671 ­ Requirements for Electrical Installations (formerly the IEE Wiring Regulations) and the guidance given by the Association for Petroleum and Explosives Administration (APEA) and the Energy Institute (EI).

This Electrical Installation Completion Certificate is intended to be issued following a new electrical installation, or new work associated with an alteration or addition to an existing electrical installation, at a filling station site. This Certificate is a valuable document and should be retained at the petrol filling station for future reference for the purpose of property maintaining the electrical installation. This certificate may only be issued by an NICEIC* Approved Contractor whose scope of enrolment includes electrical work at filling stations. They have been assessed as having the technical capability to carry out electrical work in compliance both with the national standard for the safety of electrical installations, British Standard 7671 - Requirements for Electrical Installations and the guidance given by the Association of Petroleum and Explosives Administration (APEA) and the Energy Institute (EI). This certificate is intended to inform the site operator of the condition of the work, prior to energisation, to assist them in discharging their duties under Section 4(2) of the Electricity at Work Regulations, 1989. Appendix A may be used to confirm the condition of the electrical installation for the purpose of requesting a new licence from a Petroleum Enforcing Authority. It is an offence under Section 33 of the Health and Safety at Work etc Act 1974 for any person to make a false entry on this electrical installation completion certificate. For new installation work, no defects should be recorded against the work. Such defects would indicate that the new work is in an unsatisfactory condition, which is not acceptable.

This NICEIC Filing Station Electrical Installation Completion Certificate is based on the model given in the Second Edition of the Guidance for the design, construction, modification, maintenance and decommissioning of filling stations, published jointly by the Association for Petroleum and Explosives Administration (APEA) and the Energy Institute (EI). You should have received the certificate marked `Original' and the Approved Contractor should have retained the certificate marked `Duplicate'. This Electrical Installation Completion Certificate has been issued to record the results of the initial inspection and testing of new installation work before the equipment is energised. All sections of the certificate should have been fully completed, including Appendix A. Only the NICEIC Approved Contractor responsible for the construction of the subject electrical installation work is authorized to issue this NICEIC Filling Station Electrical Installation Completion Certificate. The certificate, which consists of at least 5 pages in addition to Appendix A, must have a printed seven-digit serial number. This number is traceable to the Approved Contractor to which NICEIC supplied the certificate.

Published by NICEIC Group Limited © Copyright The Electrical Safety Council (Jan 2008)

E P S

M I C

N E

For further information about electrical safety and how NICEIC can help you, visit www.niceicgroup.com

PCN4/1&2B

PCN4/

FILLING STATION ELECTRICAL INSTALLATION COMPLETION CERTIFICATE

Issued by an Approved Contractor enrolled with NICEIC, Warwick House, Houghton Hall Park, Houghton Regis, Dunstable LU5 5ZX.

F PARTICULARS OF THE ORGANISATION(S) RESPONSIBLE FOR THE ELECTRICAL INSTALLATION

DESIGN (1)

Organisation

CONSTRUCTION

Organisation Roll No.

Address

Address

Postcode Organisation

INSPECTION AND TESTING

DESIGN (2)

Organisation

Address

Address

Postcode

G NEXT INSPECTION

§ Enter interval in terms of years, months or weeks, as appropriate

I/We, the designer(s), RECOMMEND that this installation is further inspected and tested after an interval of not more than

H SUPPLY CHARACTERISTICS AND MAIN SWITCH

System type TT

Number and type of live conductors Nature of supply parameters

E P S

1-phase, 2 wire Nominal voltage U(1) U0(1) V V BS EN BS EN Voltage rating V kA

Tick boxes and enter details, as appropriate

M I C

§

N E

Postcode Postcode Local TN-S Other TN-C-S (please state) kA External Ze(2)(3) No of supplies

TN-S

3-phase, 4 wire Nominal frequency(1) Hz Prospective fault current(2)(3)

Characteristics of primary supply overcurrent protective device(s) Main switch or circuit-breaker

Type No of poles Current rating A

Rated current Supply conductor material Rated residual RCD operating current

(1) by enquiry

A

Short-circuit capacity Supply conductor csa

kA mm2 ms

mA

RCD operating time at residual operating current

Rated fault current of forecourt switchgear

(2) by enquiry or by measurement

(3) where more than one supply, record highest value

This form is based on the model given in Design, construction, modification, maintenance and decommissioning of filling stations, published by the Association for Petroleum and Explosives Administration (www.apea.org.uk) and the Energy Institute (www.energyinst.org.uk).

Published by NICEIC Group Limited © Copyright The Electrical Safety Council (Jan 2008) for use by NICEIC Approved Contractors enrolled with NICEIC and having an appropriate extension to enrolment for electrical work at filling stations.

Page 2 of

PCN4/3

Original

(To the person ordering the work)

This certificate is not valid if the serial number has been defaced or altered

Appendix A

Certificate of Electrical Inspection and Testing at Filling Stations for New Installations Only the NICEIC Approved Contractor responsible for the initial construction of an electrical installation and having an appropriate extension to enrolment is authorized to issue an NICEIC Certificate of Electrical Inspection and Testing at Filling Stations for New Installations. These certificates may be submitted by the site operator to the Petroleum Enforcing Authority to confirm the condition of the electrical installation for the purpose of licensing. It is an offence under Section 33 of the Health and Safety at Work etc Act 1974 for any person to make a false entry on the certificate. This certificate is intended for statutory enforcement purposes only. This document is intended to be made available to the Petroleum Enforcement Authority, for the purpose of issuing a Petroleum Licence following the completion of a new installation or the refurbishment of an existing installation at a filling station. The Certification Statement gives an overall condition of the site at the time of issue, classified as A, B or C. For a new electrical installation and for one that has been newly refurbished, there must be no `unsatisfactory' outcomes for the prescribed tests and functional checks, and hence the Certification Statement must always be "A". No Defect Report should be necessary to accompany this certificate, since it only relates to failures to comply with statutory requirements. The persons completing both the electrical inspection and testing and completing the "Certificate of Electrical Inspection and Testing at Filling Stations for New Installations" need to be competent to do so. This requirement exists under the Electricity at Work Regulations 1989, the DSEAR Regulations 2002 and the Second Edition of the IP/APEA Code of Practice.

Details of the Site Operator

The site operator's name and the trading title of the organization responsible for operating the site, together with the address of the filling station, its telephone number and postcode, should clearly identify the site and those responsible for the safe use of the site.

Details of Inspection and Testing

Installation status Certification statement

This lists the various programmes which may be used for verification.

For new installations or ones which have been refurbished, the verification programme will always be 1 and 2. The overall Classification awarded to the site is entered in the box. For a new electrical installation and for one that has been newly refurbished, this must always be "A". Below there is space to record the other documents which relate to the Certification statement. The final part is for the signature and name of the person carrying out the inspection and test, the signature and name of the person responsible for reviewing and verifying the results, and the name, address, Roll number and branch (if applicable) of the Approved Contractor undertaking the work.

SP E

C

IM

There is space to record here the date of the inspection and test, together with the age of the installation. For new and refurbished installations, the age will be effectively zero years. For alterations and additions to an existing installation, the actual or, if necessary, estimated age of the pre-existing installation should be given.

E N

PCN4/11&12B

Published by NICEIC Group Limited © Copyright The Electrical Safety Council (Jan 2008)

PCN4/

FILLING STATION ELECTRICAL INSTALLATION COMPLETION CERTIFICATE

Issued by an Approved Contractor enrolled with NICEIC, Warwick House, Houghton Hall Park, Houghton Regis, Dunstable LU5 5ZX.

I RELATED REFERENCE DOCUMENTS

The inspector is required to confirm that all applicable related reference documents have been recorded. Date issued

K EARTHING ARRANGEMENTS

Means of earthing Main Earthing Terminal Main earthing conductor

Tick boxes and enter details, as appropriate

Distributor's facility Can be disconnected by a link Material

Material

Installation earth electrode Accessible Csa Labelled Continuity check

Location of electrode Resistance to earth

Inventory of Electrical Equipment No Design Drawing No

Reference

Earth electrode type

Method of Work No Risk Assessment No Hazardous Area Classification Doc. No Site Plan No Other (please state) Other (please state)

J TEST INSTRUMENTS USED

Test instrument: Earth fault loop impedance Insulation resistance Earth electrode resistance Earth leakage clamp ammeter RCD

Manufacturer

E P S

Model Serial No.

Ground conditions

L MAIN PROTECTIVE BONDING CONDUCTORS AND CIRCUIT PROTECTIVE CONDUCTORS

Csa Resistance () Csa Resistance () Csa Resistance ()

M I C

Compressor Water service Gas service Oil service

N E

Lightning protection Other Other Other

Combined earth electrode resistance, all electrodes connected in parallel RA

Canopy

Other structural metal work

Pole sign

Above ground tank Continuity Other

This form is based on the model given in Design, construction, modification, maintenance and decommissioning of filling stations, published by the Association for Petroleum and Explosives Administration (www.apea.org.uk) and the Energy Institute (www.energyinst.org.uk).

Published by NICEIC Group Limited © Copyright The Electrical Safety Council (Jan 2008) for use by NICEIC Approved Contractors enrolled with NICEIC and having an appropriate extension to enrolment for electrical work at filling stations.

Page 3 of

PCN4/5

Original

(To the person ordering the work)

This certificate is not valid if the serial number has been defaced or altered

PCN4/

FILLING STATION ELECTRICAL INSTALLATION COMPLETION CERTIFICATE

Issued by an Approved Contractor enrolled with NICEIC, Warwick House, Houghton Hall Park, Houghton Regis, Dunstable LU5 5ZX.

M CHECKLIST FOR INSPECTION OF AN ELECTRICAL INSTALLATION

1 2 3 4 5 6 7 8 9 Presence of records, diagrams and schedule information Electrical characteristics at the origin Earthing connections and main protective bonding Presence of test earth fault loop impedance socket-outlet adjacent to supply intake (non-hazardous area) Presence of lightning protection Protective measures for basic and fault protection Main switchboard and distribution boards - circuit identification

See note below

35 The location and adequacy of the tanker stand lighting is correct 36 Additional checks for all hazardous area equipment and components (this does not refer only to dispensers): a b c d e f nameplate details - accredited certification mark, certificate standard number explosion protection suitable for zone of installation correct temperature classification appropriate apparatus group or subgroup correct circuit identification

18 Selection of wiring systems and conductors for current-carrying capacity and voltage drop 19 Cables routed correctly 20 Presence of fire barriers and protection against thermal effects 21 Integrity of ducts, ducting, trenches, piping, access chambers etc. for fuel in both liquid and gaseous forms 22 Presence of signs, labels and other warning notices 23 Lighting (e.g. enclosures and seals) 24 Serviceable lamps of correct types and ratings

Labelling of circuits, protective devices, switches and terminals 25 Apparatus is suitable for environment and correctly labelled Presence of appropriate devices for secure isolation and switching 26 No damage to apparatus or wiring systems which might impair safety

10 Isolating devices capable of being locked in the `off' position 11 Choice and setting of protective and monitoring devices 12 Correct connection of socket-outlets, lamp holders and other accessories 13 Single pole devices for protection or switching in line conductors only 14 All live conductors (including neutral) are switched and isolated for hazardous area circuits, including emergency switching 15 Ancillary equipment - luminaires, socket-outlets, portable and transportable equipment 16 Selection of equipment and protective measures appropriate to external influences 17 Identification and connection of conductors

27 No unauthorised or unrecorded modifications/repairs or `add-ons` 28 No overhead lines (e.g. HV and LV power and telephone lines) over or encroaching on hazardous areas 29 No part of the hazardous area extends beyond the forecourt perimeter (including the zone around vent pipes)

N FUNCTIONAL CHECKS

E P S

See note below

30 No building opening extends into the hazardous area (including the zone around vent pipes) 31 The zone around the vent pipes is free from electrical equipment including cables 32 Suitability of residual current device (RCD) protection

M I C

N E

maintenance of integrity of enclosures g h i j k integrity of electrical connections satisfactory earthing, bonding etc. 37 Details of other items of non-compliance 38 No indication of fuel, oil or compound leakage 40 Verification of phase sequence 41 Verification of voltage drop The tanker stand lighting is functioning correctly All RCDs and circuit breakers operate correctly

cable glands, entries and stoppers etc. complete and appropriate to the enclosure

correct rating of apparatus and components adequate environmental protection, e.g. against weather, mechanical damage

39 Accessible and impervious seals in ducts / ducting / pipes

33 There is no equipment which may influence the hazardous area by, for example, displacing and /or ingesting air out of, or into, the hazardous area 34 RCD protection has been provided for dispensers

All emergency switches have red operators on yellow background An emergency stop switch is provided at every operator position An emergency stop switch is provided at each exit of the autogas compound The autogas emergency stop switch(es) functions correctly The Driver Controlled Delivery emergency stop switch functions correctly

Firefighter`s switch is at the correct height and functions correctly The public address (PA) system is operating correctly and is not disabled by the emergency stop system

Publicly-accessible emergency switching devices (where fitted) function correctly and are installed at the correct height Operator-controlled emergency switching devices function correctly The emergency switch circuit cannot be re-energized other than by an authorized person All emergency switches are correctly labelled

All boxes must be completed. ` ` indicates that an inspection or test was carried out and the result was satisfactory. `N/A' indicates that an inspection or test was ` Not Applicable' to the particular installation.

This form is based on the model given in Design, construction, modification, maintenance and decommissioning of filling stations, published by the Association for Petroleum and Explosives Administration (www.apea.org.uk) and the Energy Institute (www.energyinst.org.uk).

Published by NICEIC Group Limited © Copyright The Electrical Safety Council (Jan 2008) for use by NICEIC Approved Contractors enrolled with NICEIC and having an appropriate extension to enrolment for electrical work at filling stations.

Page 4 of

PCN4/7

Original

(To the person ordering the work)

This certificate is not valid if the serial number has been defaced or altered

PCN2/ PCN4/

FILLING STATION ELECTRICAL INSTALLATION COMPLETION CERTIFICATE

Issued by an Approved Contractor enrolled with NICEIC, Warwick House, Houghton Hall Park, Houghton Regis, Dunstable LU5 5ZX.

O TESTS PERFORMED AT INTAKE POSITION

l-n Earth fault loop impedance at test socket-outlet Prospective fault current

(tick one)

P DISTRIBUTION BOARD DETAILS

Location of distribution board:

TO BE COMPLETED IN EVERY CASE

l-e

TO BE COMPLETED ONLY IF THE DISTRIBUTION BOARD IS NOT CONNECTED DIRECTLY TO THE ORIGIN OF THE INSTALLATION

See note below

kA A A

Supply to distribution board is from: Overcurrent protective device for the distribution circuit: Type: BS(EN)

No of phases:

Nominal voltage: Associated RCD (if any): BS(EN)

V

Conductor csa:

mm2 Zs

Characteristics at this distribution board Operating times of associated RCD (if any) At In ms

Current measured in earthing conductor under normal conditions

Rating:

A

RCD No of poles:

In

Q CIRCUIT DETAILS

Max. disconnection time permitted Circuit number and phase or reference no.

Type of wiring (see code below)

Number of points served

Record lower or lowest value

Type No

Live

rated operating current, In

cpc

BS (EN)

Short-circuit capacity

Reference method

All circuits

Rating

Line/Line

Line/Neutral

Line/Earth

Neutral/Earth

Polarity

Overcurrent protective devices

RCD

Maximum Zs permitted by BS 7671

Circuit designation

Circuit conductors: csa

(mm2)

(mm2)

(s)

E P S

M I C

Circuit impedances ()

(At least one column to be completed)

R TEST RESULTS

N E

mA Ipf

kA

At 5In

(if applicable)

ms

Insulation resistance

Maximum measured earth fault loop impedance, Zs ()

RCD operating times at In (ms) at 5In (if applicable) (ms)

See note below

(A)

(kA)

(mA)

()

R1 + R2

R2

(M)

(M)

(M)

(M)

()

Note: Where the installation can be supplied by more than one source, such as a primary source (e.g. public supply) and a secondary source (e.g. standby generator), the higher or highest values must be recorded This form is based on the model given in Design, construction, modification, maintenance and decommissioning of filling stations, published by the Association for Petroleum and Explosives Administration (www.apea.org.uk) and the Energy Institute (www.energyinst.org.uk).

F

G

CODES FOR TYPE OF WIRING H O (Other - please state)

PVC/SWA cables

XLPE/SWA cables

Mineralinsulated cables

Published by NICEIC Group Limited © Copyright The Electrical Safety Council (Jan 2008) for use by NICEIC Approved Contractors enrolled with NICEIC and having an appropriate extension to enrolment for electrical work at filling stations.

Page 5 of

PCN4/9

Original

Measured value

Acceptable Max\ min values

Distribution board designation:

(To the person ordering the work)

This certificate is not valid if the serial number has been defaced or altered

PCN4/

Issued by an Approved Contractor enrolled with NICEIC, Warwick House, Houghton Hall Park, Houghton Regis, Dunstable LU5 5ZX.

DETAILS OF THE SITE OPERATOR

Name of site operator Business name Address of filling station Telephone No.

DETAILS OF THE INSPECTION AND TESTING

Date ofof Site Operator Name the inspection and test Age of electrical installation

years (approximate if relevant records are not available)

INSTALLATION STATUS

Type of site Type of verification Pre-commissioning New site or major refurbishment Initial verification Periodic verification

Availability of records

IM

Reviewed by: Signature: Inspector Name:

(CAPITALS):

Certification of design and construction, design drawings and circuit diagrams available Site electrical records available Site electrical records not available

Existing site

CERTIFICATION STATEMENT

*Delete as appropriate *A *B *C

SATISFACTORY as far as could be ascertained.

SP E

SUITABLE FOR CONTINUED USE subject to defects being remedied before the date(s) shown on the accompanying Inspection and Test Report. UNSATISFACTORY, defects observed are of a dangerous nature and require immediate attention. The presence of the recorded defects could make the site operator or their agent liable to prosecution.

The Classification awarded relates to the classification of the worst defect observed. For Classification B and C, the Defect Report should be completed.

This certificate relates to: Inventory checklist No Initial assessment No

C

I declare I am competent to sign this certificate and I hereby certify that the electrical installation in the above premises operated for the storage, use and dispensing of petroleum spirit and autogas has been inspected and tested in accordance with verification programme(s) of APEA/IP Design, construction, modification, maintenance and decommissioning of filling stations . The classification awarded is:

Dated Dated

Inspection and test report No

For the verification of the installation:

Signature:

Date:

Name: (CAPITALS):

Approved Contractor responsible for the work which is the subject of this certificate (trading title): Trading address:

NOTES

It is an offence under Section 33 of the Health and Safety at Work etc. Act 1974 for any person to make a false entry on this certificate. The person carrying out the inspection and testing must be competent, be fully conversant with BS 7671 - Requirements for electrical installations and the particular requirements for hazardous area zones in filling stations, and have practical experience of the relevant parts of BS EN 60079 Electrical apparatus for explosive gas atmospheres. All persons completing and signing this certificate are reminded of the legal requirements for competence contained in Regulation 16 of the statutory Electricity at Work Regulations. This form is based on the model given in Design, construction, modification, maintenance and decommissioning of filling stations, published by the Association for Petroleum and Explosives Administration (www.apea.org.uk) Please see the `Notes for Recipient' and the Energy Institute (www.energyinst.org.uk). on the reverse of this page.

1. 2.

Published by NICEIC Group Limited © Copyright The Electrical Safety Council (Jan 2008) for use by NICEIC Approved Contractors enrolled with NICEIC and having an appropriate extension to enrolment for electrical work at filling stations.

E N

Postcode 1 2 3 4 Date:

NICEIC Enrolment No: (Essential information) Branch Number: (if applicable) Telephone No.:

Verification programme

Dated

Qualified Supervisor (Hazardous Areas)

Appendix A

PCN4/11

Original

CERTIFICATE OF ELECTRICAL INSPECTION AND TESTING AT FILLING STATIONS FOR NEW INSTALLATIONS IN AND ASSOCIATED WITH POTENTIALLY FLAMMABLE ATMOSPHERES HEALTH AND SAFETY AT WORK ETC. ACT 1974, ELECTRICITY AT WORK REGULATIONS 1989, DANGEROUS SUBSTANCES AND EXPLOSIVE ATMOSPHERES REGULATIONS 2002

(To the person ordering the work)

This certificate is not valid if the serial number has been defaced or altered

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