App A:

Appliance Test Record

Company: ......................................................................................................................
Department: ..................................................................................................................
Location: .......................................................................................................................
Appliance description: ..................................................................................................
Make: .............................................................................................................................
Model: ...........................................................................................................................
s/n: ................................................................................................................................
Class 1, 2, 3. .....................................
Wattage:............................................

P= Pass F= Fail N= not Applicable Date Earth Insulation Flash Load Leakage Initials