M. V. _____________________ Weather: _______________ Date: ________________

ITEM	Name of Circuit	Date	Insulation Resistance (Mega Ohm)		Remarks
			Megger Last Time	Megger This Time

Note: Electrician should fill this form every 6 months, 1 copy sent to Technical Department, 1 copy kept in electrician's file.

To retain for 5 years.

Tested by ______________________ Chief Engineer ______________________

Issue date: 03.11.2003/Rev. 00 PBO-TD02-F06 Page: 1/1

INSULATION RESISTANCE TEST RECORD

QSMS PBO-TD02-F06 Rev. No.00

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