CERTIFICATE OF PORTABLE APPLIANCE

(PAT) INSPECTION AND TESTING

AWARDED TO

________________
This is to certify that on the date stated below, we performed in-service inspection and
testing of electrical equipment, on _____ appliances. Inspection and testing was
performed in accordance with the IEE Code of Practice. _____ appliances were
removed from use for safety reasons. Refer to equipment registers and/or appliance
labels for more detailed information.

Awarded this ___ day of __________, 20__

Engineer Name and Company Name