Record of equipment that has been inspected and/or tested
Note: this template can be customised to suit the needs of authorised PAT testers as a summary of the outcome of inspection and/or testing.
See Higher risk environments or activities document. Any equipment which fails its test must be removed from the area or securely
quarantined from further use until either a combined PAT has confirmed a pass result or the item has been disposed of.
Area / Department /
Section / Centre:
Test instrument used:
No.
Location of item
(Indicate room number. In
large work areas, also
indicate where item can be
found)
Name of PAT Tester:
Description of item
(One item per row. Include make /
model number if there are several
similar items)
Serial number /
unique
identification
(eg bar code no.)
Type
of test1
Pass
/ Fail
Results
Comments
(eg repair and combined PAT is required,
re-test period needs changing or item is to
be disposed of)
Date
tested
(dd/mm/yy)
Next
re-test
due
1
2
3
4
5
6
7
1
Record the type of test carried out; formal visual inspection eg using ‘FVI’ or combined PAT eg using ‘C’ or ‘Combined’.
PAT: Record of equipment inspected and/or tested
Issue 2: June 2013
Page 1 of 2
PAT: Record of equipment inspected and/or tested
Issue 2: June 2013
Page 2 of 2