Notes: 1

This form is based is based on the model in Annex D of BS 5266: Part 1: 2005Please see the 'Notes for Recipient' on the

following pages of page 1 and 2

Delete as appropriate*

RELATED REFERENCE DOCUMENTSPeriodic Inspection Report No. and/or date of most recent - covering the existing emergency lighting installation - see Note 1

None made available at the time of testing

SJH09/09/2009Contractors Reference Number

Please refer to deviations section of this report

F

Other documents (if any) please state

None

Enter interval in accordance with clause 7.2 of BS EN 50172: 2004 / BS 5266-8: 2004NEXT INSPECTION

The wiring system of an existing emergency lighting system should have been periodically inspected and tested in accordance with BS 7671 and a Periodic Inspection Report issued. Where applicable and where available, the serial number and/or date of the most recent report should be recorded in the space provided

YesAdditional information has been supplied on page 3 No

I/We*, the person identified in C, RECOMMEND that this installation is further inspected and tested after an interval of not more than 3 Years

E

Date 09 September 2009

01245 461931

I / we* hereby certify that the emergency lighting system installation at the above premises has been inspected and tested by me/us* in accordance with the 'Results Schedule of items inspected and tested' on page 2, and to the best of my / our* knowledge and belief, the installation complies at the time of my/our* inspection and testing with the recommendations given in BS 5266 - 1: 2005 Emergency lighting Part 1: Code of practice for the emergency lighting of premises, BS EN 1838: 1999 / BS 5266- 7: 1999 Lighting applications - Emergency lighting BS EN 50172: 2004 / BS 5266-8: 2004 Emergency escape lighting systems, except as stated in section D.

Name (CAPITALS) Stuart Harris

Trading title

Requirement No

DETAILS OF DEVIATIONS FROM THE CURRENT STANDARDSDetails of deviations (Additional space to continue list is provided on page 3)

CM1 6XJ

Signature Stuart Harris Inspector

Telephone No

Postcode

S J Harris Electrical Ltd

EC2V 4ER

A DETAILS OF THE CLIENT

B DETAILS OF THE EMERGENCY LIGHTING INSTALLATION

Orig

inal

(To

the

pers

on o

rder

ing

the

wor

k)

65 Crocus WayNorth SpringfieldChelmsfordEssex

D

Museum of London, Blackfiars Lane, London

Periodic Inspection & Testing - 100% of the existing Emergency Lighting Installation for compliance with the current Regulations BS 5266-1: 2005

Extent of the installation covered by this certificate

NW14 4QR

Address

To certify continued compliance of an existing installation

This certificate is not valid unless accompanied by pages 2 and 3

CRN

S J Harris Electrical LtdElectrical Installation & Test Engineers EMERGENCY LIGHTING PERIODIC

INSPECTION AND TESTING CERTIFICATE

Occupier/ Client

Contractor responsible for carrying out the inspection and testing (address)

* Delete as appropriateC

PURPOSE OF CERTIFICATE

Postcode

Postcode

City of London

CERTIFICATION

abcd

S J Harris Electrical Ltd - Tel: 01245 461931 Fax: 01245 461932 Mob: 07985 595555 Email info@sjhe.co.uk

(Scotland) or the Employer or Nominated Employee (Northern Ireland) for the premises that the emergency lighting

of the pages of this certificate would render the certificate invalid. Additionally, where any of the boxes havebeen left blank without reasonable justification, you should seek to question with the Contractor as to why thecertificate has not been fully completed.

The Emergency Lighting Periodic Inspection and Testing Certificate is to be issued only for the periodic inspectionand testing of an existing emergency lighting installation that was installed to, or has previously been verifiedcompliant with, BS 5266-1: 2005, BS EN 1838: 1999/BS 5266-7: 1999 and BS EN 50172: 2004 / BS 5266-8: 2004. The

a new 'Fire Risk Assessment' should be carried out.

Electrical Installations, at the time the certificate was issued (if accompanied with a current 'Periodic Inspection Report' on the electrical installation, as prescribed by BS 7671). If there is a change of use of the building or a change in occupancy

The 'Original' certificate should be retained in a safe place and shown to any person inspecting or undertaking further workon the emergency lighting installation in the future. If you later vacate the property or building, this certificate will demonstrate to the nre Responsible Person or Competent Person (England and Wales), Employer or Other Persons

installation continues to comply with the requirements of BS 5266 Parts 1, 7 and 8 and with BS 7671 Requirements for

You should have received the certificate marked 'Original' and the Contractor should have retained the certificate markedDuplicate'. This certificate is a valuable document and should be retained for future reference for the purpose ofproviding evidence of properly maintaining the emergency lighting installation. If you were the person orderingthe work, but not the user of the installation, you should pass this certificate, immediately to the Responsible Person orCompetent Person (England and Wales), Employer or Other Persons (Scotland) or the Employer or NominatedEmployee (Northern Ireland) for the premises.

Regulations (Northern Ireland 2000), to continue to declare, that the existing emergency lighting system to which itrelates has been inspected and tested in accordance with the appropriate recommendations given in BS 5266Emergency Lighting Part 1: 2005 Code of Practice for the emergency lighting of premesis, BS EN 1838: 1999/BS 6266-7:1999 Lighting applications - Emergency lighting, and BS EN 50172: 2004/BS 5266-8: 2004 Emergency escape lightingsystems, to verify that the emergency lighting installation continues to compl with these standards.

NOTES FOR RECIPIENTS

person who through contract or tenancy have obligations in respect of maintenace or safety (as required by Fire (Scotland)Act 2005) or The Employer or Nominated Employee who has special responsibility for fire safety (as required by the

a new emergency lighting installation ornew work associated with an alteration oran addition to an existing emergency lighting installation orverification of an existing installation (installed to a previous edition of the standards) for compliance with the

This certificate has been issued to provide supporting evidence (along with the client's current 'Fire RiskAssessment'), to enable the Responsible Person or Competent Person acting on their behalf, (as required by the Management of Health and Safety at Work Regulations 1999 and the Regulatory reform (Fire Safety) Order 2005 in

The Fire Precautions (Workplace) Regulations (Northern Ireland) 2001) anf The Management of Health and Safety at Work

purpose of the certificate is to verify continued compliance of the installation with those standards.

This 'Emergency Lighting Periodic Inspection and Testing Certificate' consists of three pages. The absence of any

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

The certificate must not be issued for any of the purposes a, b, c or d below, for which an Emergency LightingCompletion Certificate must be issued:

current edition of the standards.

England and Wales) or The Employer or Other Persons who have control over the premise to any extent and any

P2-

P5-

P8-

P12-

P14-

P18-

P20-

P21-

P22-

Notes:

Contractors Reference Number

KL01246

13.4 After test, the charging indicators operate correctly

13.3

P1-

Clause 6

P3-

–Serial No.

TEST INSTRUMENTS USED

CRN SJH09/09/2009

–

Plans are available and correct

Original deign still valid

Correct application and siting of additional emergency lightingLuminaires conform to BS EN 60598-2-22

Wiring systems comply with the requirements of BS 7671

This form is based is based on the model in Annex D of BS 5266: Part 1: 2005

Kew Lux Meter

KInstrument 2 (if any) Model

Please see the 'Notes for Recipient' on the following page

Serial No.

Where periodic requirement P2 is carried out by measurement, details of instruments MUST be recorded.

Instrument 1 (light meter) Model

Because of the posibility of failure of the supply to the normal lighting occuring shortly after a period of testing, all tests should be undertaken at times of minimum risk. Alternatively, suitable temporary arrangements should be made until the batteries have been recharged.

–

P23-

Evidence of servicing of Standby Generator System (in line with manufacturer's procedures); in-house or current maintenance contract is in place

–

G PURPOSE OF INSTALLED EMERGENCY LIGHTING SYSTEM Tick applicable box(es)

Open area lighting High risk task area lighting–

–

Orig

inal

(To

the

pers

on o

rder

ing

the

wor

k)

Emergency escape lighting

Escape route lighting

Standby lighting

Partial standby lighting

EMERGENCY LIGHTING PERIODIC INSPECTION AND TESTING CERTIFICATE

SCHEDULE OF ITEMS INSPECTED AND

S J Harris Electrical LtdElectrical Installation & Test Engineers

This certificate is not valid unless accompanied by pages 1 and 3

CATAGORIES OF OPERATION FOR EMERGENCY LIGHTING SYSTEM

Non maintained – Isolation of protective devices 1 Hour

– Key Switches 1 Hour

J RESULTS OF INSPECTION AND TESTING Where the 'No' column is ticked, the deviation must be recorded in section D on page 1

*

Central battery system – Standby generator system –

I

BS 5266-1 clause reference

Requirements

4.2

Type Mode Facilities Duration

Maintained

H EMERGENCY LIGHTING INSTALLATION ARRANGEMENT

Self-contained emergency luminaire

Tick applicable box(es)

Combined emergency luminaire

Yes No* N/A

System conform (indicate with a tick)

Under test conditions, adequate** illumination provided for safe movement on the escape route and the open areasLuminaires correctly positioned and oriented as shown on the plans6.3

6.3 P4-

6.6

P6-

All escape route safety signs and fire fighting equipment location signs visible with the normal lighting extinguished

7.87.9 P7-

9.1 P9-

Luminaires have an appropriate Ingress Protection rating for their location, as specified in the system design7.9

9.2.5 P11-9.2 P10-

Emergency cicuits correctly segregated from other suppliesFire protection of central wiring systems satisfactory

9.3.3 P13- System has a suitable test facility for the application

Wiring to emergency lighting supply power sources a fixed installation, where a specialist plug and socket arrangement is used, it is protected against unauthorized interference9.2.12

10.1 P15- Luminaires tested and found to operate for their full rated duration

9.3.5

P16- Operation and maintenance

Central power system output voltage range is compatible with the supply voltage range of the luminaires, taking into account supply cable voltage drop

12 P17- Test records in the log book complete and satisfactory11.6

13 P19- Luminaires clean and undamaged with lamps in good condition

Instructions together with a suitable log book showing a satisfactory commissioning test available for use by the building occupier12.3

Evidence of servicing of Central Battery System (in line with manufacturer's procedures); in-house or current maintenance contract is in place13.2

Building occupier and their staff trained on suitable maintenance, testing and operating procedures, or a current maintenance contract is in place13

Page 1 of the Certificate (continued)

The Emergency Lighting Periodic Inspection and Testing Certificate is to be issued only for the periodic inspection andtesting of an existing emergency lighting installation that was installed to, or has previously been verified compliant withBS 5266-1: 2005, BS EN 1838: 1999/BS 5266-7: 1999 and BS EN 50172: 2004 / BS 5266-8: 2004. The purpose of thecertificate is to verify continued compliance of the installation with those standards.

Provision is made for the contactor's trading title, address, the name and signature of the person certifying the periodicinspection and testing of the emergency lighting installation.

A section is provided for recording details of all deviations from the Code of Practice (BS 5266: Part 1) found during theinspection and testing of the emergency lighting installation. Page 3 provides additional space for use where more thanfive deviations exist.

Provision is made for recording any related reference documents for the emergency lighting periodic inspection and testingof the installation, and 'The Periodic Inspection Report' serial numbers (where applicable).

For safety reasons, the emergency lighting installaMuseum of London c/o City of Londonappropriate intervals. Provision is made towards the bottom of the page to record a recommendation that the emergencylighting installation should be inspected and tested at a specified interval, in accordance with clause 7.2 of BS EN 50172:2004/BS 5266-8: 2004. The standard recommends that you engage the services of a competent contractor for this purpose.Additionally, inspections will be required to be undertaken by the Responsible Person or Competent Person (Englandand Wales), Employer or Other Persons (Scotland) or the Employer or Nominated Employee (Northern Ireland) for thepremises on daily, monthly and annual basis, in accordance with BS 5266: Part 1: 2005 and recorded in the emergencylighting log book.

Page 2 of the Certificate

Page 2 provides space for the Contractor to record system information on the 'purpose', 'installation arrangements' and thecatagories of operation' of the installed emergency lighting system.

Provision is also made for the result of each of the prescribed inspections and tests to be seperately recorded in theResults Schedule of Items Inspected and Tested'. All 'requirement boxes' should have been completed by the insertion ofYES' (or ' '), 'NO' or 'N/A' meaning 'Not Applicable', as appropriate.

Should the person ordering the periodic inspection and testing of the emergency lighting installation (e.g. the client, asidentified on Page 1 of this certificate), or the Responsible Person or Competent Person (England and Wales),Employer or Other Persons (Scotland) or the Employer or Nominated Employee (Northern Ireland) for the preises, havereason to doubt the accuracy of this certificate, in the first instance the specific concerns should be raised in writing withthe Contractor.

Page 3 of the Certificate

Section L, on page 3 entitled 'Comments (if any)' has been provided to enable the Contractor to give additional relevantinformation (that are not deviations from the standard) on the general condition of the emergency lighting installation.

Section M is provided for recording details of additional deviations from the recommendations of BS 5266: Part 1 foundduring the inspection and testing of the emergency lighting installation, where there is insufficient space on page 1 of thecertificate.

Where a test instrument has been used, for example, to measure the illuminance provided by the emergency lightinginstallation, a record of the model and serial number should have been recorded in the spaces provided in Section K. Whereno instrument has been used, the entries for 'Instrument 1 and 2, Model' should read 'None used'. The contractor shouldprovide information in Section N of the certificate on page 3, on the alternative method used to verify the required illuminancelevels.

S J Harris Electrical Ltd - Tel: 01245 461931 Fax: 01245 461932 Mob: 07985 595555 Email info@sjhe.co.uk

NOTES FOR RECIPIENTSTHIS CERTIFICATE IS A VALUABLE DOCUMENT AND SHOULD BE RETAINED FOR FUTURE REFERENCE

O

N

Please see the 'Notes for Recipient' after page 2This form is based is based on the model in Annex D of BS 5266: Part 1: 2005

Lux meter used only - Night work

Please refer to deviations section of this report

M DETAILS OF DEVIATIONS FROM THE STANDARDS Continued from page 1

S J Harris Electrical LtdElectrical Installation & Test Engineers

This certificate is not valid unless accompanied by pages 1 and 3

EMERGENCY LIGHTING PERIODIC INSPECTION AND TESTING CERTIFICATE

Requirement No

DETAILS OF DEVIATIONS FROM THE STANDARDS

Details of deviations

Contractors Reference Number

CRN SJH09/09/2009 COMMENTS ON INSTALLATION AND FURTHER

COMMENTS (if any)L

INFORMATION ON ALTERNATIVE METHOD USED TO VERIFY ILLUMINATION REQUIREMENT P2