FORM II

INSTALLATIONS OF VOLTAGE LEVEL MORE THAN 250V UP TO AND

INCLUDING 650V
Report No: Date of Inspection by Electrical Inspector or self certification by
.............................. owner: ................
Date of Last Inspection or self certification:
......................................................................................................

1 .Consumer Name: .................................................................................................

2 .Voltage and system of supply:
(i) Volts.........................................................................................
(ii) No. of Phases ......................................................................
(iii) AC/ DC ........................................................................
3 .Name of the consumer or owner ........................................................................
4 .Address of the consumer or owner ........................................................................
5 .Location of the premises ........................................................................
6 .Particulars of the installations
(a) Motors
Make No. H.P Amps Voltage
....................... ............................ ............................ ............................ ............................
(i)
................ ........... ........... ........... ...........
............................ ............................ ............................ ............................ ............................
(ii)
........... ........... ........... ........... ...........
(b) Other equipments (complete details to be furnished):
(i) ...................................................................
(ii) ...................................................................
Total Connected Load in HP/ KVA .....................................................
(c) Generator Details i.e. Make, [Link]., KVA rating and Voltage
(i) ...................................................................
(ii) ...................................................................

General conditions of the installations:

Sl Regulations
Requirements Report
No. Nos
Is the register of designated persons properly made
7 Regulation 3 Yes/ No
and kept up to date duly attested?
8 Regulation 12 (i) Is/ Are there any visible sign(s) of overloading in Yes/ No
 respect of any apparatus wiring?
(ii) Whether any unauthorized installation exists? Yes/ No
(iii) Are the electric supply lines and apparatus so
installed, protected, worked and maintained as to Yes/ No
prevent danger?
(iv) Any other general remarks Yes/ No
Give report on the condition of the service lines,
Satisfactory/
cables wires, apparatus and such other fittings placed
9 Regulation 13 Not
by the supplier or owner of the premise. If not
satisfactory
satisfactory, give details
Whether suitable cut-outs provided by the supplier at
10 Regulation 14 the consumer's premises are within enclosed fire Yes/ No
proof receptacle?
11 Regulation 15 (i) Whether switches are provided on live conductors Yes/ No
(ii) whether indication of a permanent nature is
provided as per Regulation so as to distinguish neutral Yes/ No
conductor from the live conductor
(iii) Whether a direct line is provided on the neutral in
the case of single phase double pole iron clad Yes/ No
switches instead of fuse?
12 Regulation 16 (i) State if earthed terminal is provided by the supplier Yes/ No
Satisfactory/
(iii) General visible conditions of the earthing
Not
arrangement.
satisfactory
13 Regulation 17 (i) Are bare conductors in building inaccessible? Yes/ No
(ii) Whether readily accessible switches have been
Yes/ No
provided for rendering them dead?
Whether "danger notice" in Hindi and the Local
language of the district and of a design as per
14 Regulation 18 Yes/ No
relevant Indian Standard is affixed permanently in
conspicuous position?
15 Regulation 19 (i) Whether insulating floor or mats conforming to IS-
Yes/ No
15652:2006 have been provided?
(ii) Whether identification of panel has been provided
Yes/ No
on the front and the rear of the panel?
Whether flexible cables used for portable or
transportable equipment covered under the
16 Regulation 21 Yes/ No
Regulation, are heavily insulated and adequately
protected from mechanical injury?
Satisfactory/
State the condition of metallic coverings provided for
17 Regulation 22 Not
various conductors.
satisfactory
18 Regulation 24 Whether the circuits or apparatus intended for Yes/ No
 operating at different voltage(s) are distinguishable by
means of induction(s) of permanent nature?
Whether all circuits and apparatus are so arranged
that there is no danger of any part(s) becoming
19 Regulation 26 Yes/ No
accidentally charged to any voltage beyond the limits
of voltage for which it/they is/are intended?
20 Regulation 27 (i) In the case of generating stations, whether fire
buckets filled with clean dry sand have been
conspicuously marked and kept in convenient Yes/ No
situations in addition to fire extinguishers suitable for
dealing with electric fires?
(ii) Whether First Aid Boxes or cupboards
conspicuously marked and properly equipped are Yes/ No
provided and maintained?
(iii) Is adequate staff trained in First Aid Treatment
Yes/ No
and fire fighting?
21 Regulation 28 (i) Whether instructions in English or Hindi and the
local language of the district and where Hindi is the
local language, in English and Hindi, for the resection Yes/ No
of persons suffering electric shock have been affixed
in a "conspicuous place"?
(ii) Are the designated persons able to apply
instructions for resuscitation of persons suffering from Yes/ No
Electric Shock?
Leakage on Premises:
22 Regulation 34 State insulation resistance between conductors and ..... .M Ohms
earth in Mega ohms
23 Regulation 35 (i) Whether a suitable linked switch, or circuit breaker
is placed near the point of commencement of supply
Yes/ No
so as to be readily accessible and capable of being
easily operated to completely isolate the supply?
(ii) Whether every distinct circuit is protected against
excess electricity by means of a suitable circuit Yes/ No
breaker or cut-out?
(iii) Whether suitable linked switch or circuit breaker is
provided near each motor or apparatus for controlling Yes/ No
supply to the motor or apparatus
(iv) Whether adequate precautions are taken to
ensure that no live parts are so exposed as to cause Yes/ No
danger?
24 Regulation 37 (i) Whether clear space of 100 cm is provided in front
Yes/ No
of the main switchboard?
(ii) Whether the space behind the switch board
Yes/ No
exceeds 75 cm in width or is less than 20 cm?
 (iii) In case the clear space behind the switchboard
exceeds 75 cm., state whether a passage way from
Yes/ No
either end of the switchboard to a height of 1.80
meters is provided.
25 Regulation 41 (i) Has the neutral point at the transformer and
generator been earthed by two separate and distinct Yes/ No
connections with earth
(ii) Have the frame of every generator, stationary
motor and so far as practicable portable motor and the
metallic parts (not intended as conductors) of all
transformers and any other apparatus used for
Yes/ No
regulating or controlling electricity and all apparatus
consuming electricity at all voltages exceeding 250 V
but not exceeding 650 V been earthed by two
separate and distinct connections with earth?
(iii) Have the metal casings or metallic coverings
containing or protecting any electric supply line or
apparatus been properly earthed and so joined and Yes/ No
connected across all junction boxes as to make good
mechanical and electrical connection?
(iv) Whether the consumer's own earth electrode,
Yes/ No
state if it is properly executed and has been tested. If
.... .M Ohms
yes, give value of earth resistance.
(v) Have the earth wire free from any mechanical
Yes/ No
damage
Have the protections and interlocks for the generating
26 Regulation 45 Yes/ No
units been provided. If not, give details?
27 Overhead lines (i) State if the consumer has any overhead lines. Yes/ No
(ii) Does the overhead line near the premises of
consumer meets the requirement of regulations 58, 60 Yes/ No
and 61? If not, give details.
(iii) Is guarding provided for the overhead lines at road
Yes/ No
crossings?
(iv) Any other remarks

Date: Signature of the Inspection officer/ Self Certifying supplier or

.............................. owner
Name: .....................
Designation: ..............
File No: .....................

Copy forwarded to the concerned Electrical Inspector for .........................................