Occupational Health and Safety Act, 1993 (Act No. 85 of 1993)

Electric Fence System Certificate of Compliance in accordance with regulations 12(4) and 13(1) of the Electrical Machinery Regulations, 2011

Certificate No.

Certificate Type

(Tick appropriate block)

Initial Certificate

Supplementary Certificate

Supplement No ................. to Initial Certificate No ................... as issued on:

Identification of the relevant installation

(Address or other unique reference, where applicable)

Physical address:

..................................................................................…….....................................

..............................................................................…........................................….

Name of premises: ........................................ GPS Coordinates: .......................

Suburb/Township: ......................................... Pole number: ...............................

District/Town/City: ............................................ Erf/Lot No.: ...............................

Declaration by registered electrical fence installer

I .......................................................................................................................

(ID No. ........................................),

a registered electric fence system installer, declare that I have personally carried out the inspection and testing of the electric fence system described above as per the requirements of regulation 13(1), and deem the installation to be reasonably safe when properly used.

Registered person registration number: .............................................................

Date of registration: ……………..............................................................................

Signature: ...............…………….......……......................... Date: ...............................

Contact details of registered person:

Tel No:

Fax No.

Cell No.

Email

Address

...............……………....……………………..........

...............……………....……………………..........

...............……………....……………………..........

...............……………....……………………..........

Declaration by user or lessor

I declare that I am aware of my responsibilities in terms of regulation 12 of the Electrical Machinery Regulations and undertake to operate and maintain the electric fence system in a safe manner

Recipient Name: ....................... Signature: ......................... Date: .......................