Department of Mines, Industry Regulation and Safety Mines Safety and Inspection Regulations 1995Mine 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the full name of the electrician authorized to complete Electrical Safety Certificates in the designated field.
3. Next, input the EW Number associated with the electrician. This is crucial for identification purposes.
4. In the signature field, ensure that the electrician signs to validate their authorization.
5. Specify the expiry date of this authorization as determined by the electrical contractor. This ensures compliance with regulations.
6. Proceed to fill out the details of the electrical contractor, including Business Name and Business Address.
7. Enter the Postcode and Phone Number for easy contact reference.
8. Input the EC Number and have the Principal of Business print their name and sign in the respective fields.
9. Finally, indicate the Date Authorisation Granted to complete this form accurately.

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