[ III— 4] 1

To: Office of Electrical Inspector for ………………...

FORM III
(See Regulation 32 and 45)
(Installations of voltage exceeding 650 V)

Report / Application No.

120

Date of inspection by Electrical Inspector or self-certification by supplier/owner/consumer

26/08/25
Date of last inspection or self-certification 28/08/25

1. Consumer No. 9907435344

2. Voltage and system of supply:

(iii) Volts
(ii) No. of Phases (iii) AC/DC
1. Name of the consumer or owner Leela bai / W/O Gulab singh
1. Address of the consumer or Village Bhaunkhedi ICCHAWAR SEHORE
2. Location of the premises owner Village Bhaunkhedi ICCHAWAR SEHORE
3. Particulars of the installations: 25 KVA DTR WORK
(a) Transformers: (complete detail to be enclosed)

Make S. No. kVA/MVA rating Voltage rating Type

(i) WESTERN ELECTIRICALS WE/47186 11/0.433 5 STAR

(ii)

(b) Generators: (complete detail to be enclosed)

Make S. No. kVA/MVA rating Voltage rating Type

(v)
(vi)

(c) List of Motors with rating, protection, overload setting, size of earth conductor used to be furnished
Make S. No. kW/MW rating Voltage rating Type

(iii)

(iv)

(d) List of equipment with complete details of HT /LT switchgears/ apparatus with their rating to be furnished):
(iii)
(iv)
2 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4]
(e) Total connected load kW / kVA 15 KW
Complete list of connected loads to be furnished.
4. General condition of the installation:
Sl. Regulation No. Requirements Report
No.
1
NEW LOAD

2
15 KW 15 KW
[ III— 4] 3

1. Regulation 3 Is the record of the designated persons properly made and kept
up to date and duly attested? ª√Yes/No

2. Regulation 5 Whether Electrical Safety Officer as required under the Yes/No √

Regulation is designated?
Regulation 14 (i) Is/Are there any visible sign(s) of overloading in respect Yes/No √
of any apparatus?
(ii) Whether any unauthorised temporary installation exist? Yes/No √
(iii) Whether the motors and controlling equipment are Yes/No/NA √
being overhauled periodically and record kept of the
same in a register?
(iv) Whether the transformer oil samples are being tested √ Yes/No
periodically and results recorded in a register? State
value of dielectric strength of oil. 58.5 kV/mm

(v) Whether suitable lightning arresters have been provided √ Yes/No

near the transformers for protection against lightning?
(vi) Whether earth resistance is being measured periodically Yes/No √
once a year and results recorded in a register? Copy of
record to be enclosed.
(vii) Any other defect or condition which may be a source of Yes/No/NA √
danger. If yes, please explain?
(viii) Whether operation and maintenance data has been Yes/No/NA √
clarified, categorised and computerised for prompt and
easy retrieval?
(ix) Whether residual life assessment and life extension √ Yes/No
programmes are being undertaken for installations or
equipment of voltage exceeding 650 V (applicable for
installations or equipment more than 15 years old)?
(x) Whether all required type and routine tests at factory Yes/No/NA √
done for equipment? Deficiencies and discrepancies in
above test report and results, if any, shall be reported.
(xi) Are there deficiencies in construction with reference to Yes/No/NA √
Indian Standard requirements? Please specify.
4. Regulation 15 Give report on condition of service lines, cables, wires, √ Satisfactory/
apparatus and such other fittings placed by the supplier or
owner of the premises. If not satisfactory, give details. Not Satisfactory

5. Regulation 16 Whether suitable cut-outs/CBs provided by the supplier at the √ Yes/No

consumer’s premises are within enclosed fire proof
receptacle?
6. Regulation 17 (i) Whether switches are provided on live conductors? √ Yes/No
(ii) Whether indication of a permanent nature is provided as √ Yes/No
per Regulation so as to distinguish earthed or earthed
neutral conductor from the live conductor?
(iii) Whether a direct line is provided on the neutral in the case Yes/No √
of single-phase double pole iron clad switches/CBs
instead of fuse?
7. Regulation 18 (i) Whether earthed terminal is provided by the supplier? √ Yes/No
(ii) General visible condition of the earthing arrangement. √ Satisfactory/
Not Satisfactory
4 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4]

8. Regulation 19 (i) Are live parts in building inaccessible? √ Yes/No

(ii) Whether readily accessible switches have been provided √ Yes/No
for rendering them dead?
9. Regulation 20 Whether “Danger Notice” in Hindi and the local language of √ Yes/No
the district and of a design as per the relevant standards is
affixed permanently in conspicuous position?
10. Regulation 21 (i) Whether the practice of working on live lines and √ Yes/No
apparatus is adopted? If so, have the safety measure been
adopted as per Schedule I?
(ii) Whether insulating floor or mats conforming to the Yes/No/NA √
relevant standards have been provided?
(iii) Whether identification of panel has been provided on the Yes/No/ NA √
front and the rear of the panel?
11. Regulation 23 Whether flexible cables used for portable or transportable √ Yes/No
equipment covered under the Regulation, are heavily insulated
and adequately protected from mechanical injury?
12. Regulation 24 State the condition of metallic coverings provided for various √ Satisfactory/
conductors.
Not Satisfactory
13. Regulation 26 Whether the circuits or apparatus intended for operating at √ Yes/No
different voltage(s) are distinguishable by means of
indication(s) of permanent nature?
14. Regulation 28 Whether all circuits and apparatus are so arranged that there is √ Yes/No
no danger of any part(s) becoming accidentally charged to any
voltage beyond the limits of voltage for which it/they is/are
intended?
15. Regulation 29 (i) In the case of generating stations and enclosed sub √ Yes/No
stations, whether fire-buckets filled with clean dry sand
have been conspicuously marked and kept in convenient
location in addition to fire-extinguishers suitable for
dealing with electric fires?
(ii) Whether First Aid Boxes or cupboards conspicuously √Yes/No
marked and properly equipped are provided and
maintained?
(iii) Is adequate staff trained in First Aid Treatment and √ Yes/No
firefighting?
16. Regulation 30 (i) Whether instructions in English or Hindi and the local √ Yes/No
language of the district and where Hindi is the local
language, in English and Hindi, for the resuscitation of
persons suffering from electric shock have been affixed in
a “conspicuous place”?
(ii) Are the persons mentioned in this regulation able to √ Yes/No
apply instructions for resuscitation of persons suffering
from electric shock?
17. Regulation 36 State insulation resistance between conductors and earth in 100 Mega Ohms
Mega Ohms.
18. Regulation 37 (i) Whether a suitable linked switch, or a circuit breaker, or √ Yes/No
an emergency tripping device is placed near the point of
commencement of supply so as to be readily accessible
and capable of being easily operated to completely isolate
the supply?
(ii) Whether suitable linked switch or a circuit breaker to √ Yes/No
carry and break the full load current is provided on the
[ III— 4] 5

secondary side of a transformer?

(iii) Whether every distinct circuit is protected against excess √ Yes/No
electricity by means of a suitable circuit breaker or cut-
out?
(iv) Whether linked switch or circuit breaker or emergency √ Yes/No
tripping device is provided near the motor or other
apparatus at voltage exceeding 650 V but not exceeding
33kV for controlling supply to the motor or apparatus?
(v) Whether adequate precautions are taken to ensure that no √ Yes/No
live parts are so exposed as to cause danger?
19. Regulation 39 (i) Whether clear space of 100 cm is provided in front of the √ Yes/No
main switchboard?
(ii) Whether the space behind the switchboard exceeds 75 √ Yes/No
cm in width or is less than 20 cm?

(iii) In case the clear space behind the switchboard exceeds √ Yes/No
75 cm, state whether a passage way from either end of the
switchboard to a height of 1.80 metre is provided.
20. Regulation 46 (i) Whether all conductors and apparatus including live Yes/No/NA√
parts thereof are inaccessible

(ii) Whether all windings of motors or other apparatus are Yes/No/NA√

suitably protected?
(iii) Whether the separation wall or fire wall between Yes/No/NA√
apparatuses or consumer premises, in a substation or a
switching station with apparatus having more than 2000
litres of oil are installed, have been provided as required
under the regulation?
(iv) Where 9000 litre or more of oil is used in any one oil Yes/No/NA√
tank, has provision been made for draining away or
removal of oil which may leak or escape from such
tank(s)?
(v) Whether suitable firefighting system as per the regulation Yes/No/NA√
has been provided?
(vi) Whether trenches inside substation containing cables are Yes/No/NA√
filled with non-inflammable material or completely
covered with non-inflammable slabs?
(vii) Are conductors and apparatus so arranged that they may
be made dead in sections for carrying out work thereon? Yes/No/NA √
21. Regulation 47 Whether protections and interlocks have been provided? Give √ Yes/No
the details of the protection schemes and their settings.
22. Regulation 50 (i) Have all non-current carrying metal parts associated with √ Yes/No
the installation been effectively earthed with the earthing
system or mat by two separate and distinct connections?
(ii) Is the earth wire free from any mechanical damage? √ Yes/No
(iii) Has the neutral point at the transformer and generator √ Yes/No
been earthed by two separate and distinct connections
with earth?
(iv) Have the metal casings or metallic coverings containing √ Yes/No
or protecting any electric supply line or apparatus been
properly earthed and so joined and connected across all
junction boxes as to make good mechanical and
6 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4]

electrical connections throughout their whole length?

(v) Whether earthing has been properly executed and has √ Yes/No
been tested. If yes, give value of earth resistance.
Ohm
23. Regulation 51 (i) Is the outdoor (except pole type) substation efficiently √ Yes/No
protected by fencing not less than 1.8 metre in height?
(ii) Whether the mounting of a transformer on a single pole or √ Yes/No
H pole is done as per relevant standard.
24 Regulation 52 (i) Where platform type construction is used for pole type √ Yes/No
substation, has sufficient space for a man to stand on the
platform been provided?
(ii) Has hand-rail been provided and connected with earth (if √ Yes/No
metallic and if substation has not been erected on wooden
supports and wooden platform)?
25. Regulation 53 Has suitable provision been made for immediate and √ Yes/No
automatic or manual discharge of every static condenser on
disconnection of supply?
26 Overhead Lines (i) What is the minimum size of the conductors of overhead Minimum size of
lines used? State the type of conductors. (Regulation 57) Conductor 0.75
(ii) Whether clearances above ground of the lowest conductor Yes/No/NA√
of overhead lines are as per regulation 60? State
clearance. --- metre

(iii) On the basis of maximum sag, whether vertical clearances Yes/No/NA√

where the line of voltage exceeding 650 V passes above
or adjacent to any building or part of a building as per --- metre
regulation 63? State clearance.
(iv) On the basis of maximum deflection due to wind pressure, Yes/No/NA√
whether horizontal clearances between the nearest
--- metre
conductor and any part of such building are as per
regulation 63? State clearance.
(v) Where conductors forming parts of system at different Yes/No/NA√
voltages are erected on the same supports, whether
adequate provision has been made as per regulation 64 to
guard against danger to linemen and others from the
lower voltage system being charged above its normal
working voltage by leakage from or contact with the
higher voltage system?
(vi) Where overhead lines cross or are in proximity to each Yes/No/NA√
other whether they have been suitably protected to guard
against possibility of their coming in contact with each
other as per regulation 71?
(vii) Has every guard wire been properly earthed as per Yes/No/NA√
regulation 72 at each point at which its electrical
continuity is broken?
(viii) (a) Whether metal supports of overhead lines and Yes/No/NA√
metallic fittings attached thereto are permanently earthed
as per regulation 74?
(b) Has each stay-wire (except in case where an insulator
has been placed in it at a height not less than 3 metre YES/NO/NA √
from the ground) been earthed as per regulation 74?
(ix) (a) Whether overhead line is suitably protected with a Yes/No/NA√
device for rendering the line electrically harmless in case
[ III— 4] 7

it breaks as per regulation 76? Yes/No/NA√

(b) Whether anti-climbing devices have been provided at
each support as per regulation 75?
(x) (a) Has the owner of overhead lines adopted efficient Yes/No/NA√
means for diverting to earth any electrical surges due to
lightning in every overhead line which is so exposed as
to be liable to injury from lightning as per regulation 77?
(b) Whether earth lead from the lightning arresters is
connected to a separate earth electrode as per regulation YES/NO/NA√
77?
(xi) Whether unused overhead lines are maintained in a safe Yes/No/NA√
mechanical condition as per regulation 78?
(xii) Whether statutory clearances from Authorities i.e. Forest Yes/No/NA√
Department/Railways/PTCC/Defence (AHQ) /Civil
Aviation have been taken as per the relevant standards. If
yes, enclose copies of the same.
(xiii) Any other remarks. Yes/No√

In addition to above, following electrical equipment wise test details to be given, if applicable:
Sl. Equipment Test Conducted Test Results Remarks
No.
1. Linked Switch with (i) Mechanical operation √ Smooth/Trouble some
fuses (s) (ii) Rating of Fuse 7.5 Amps
(iii) Contact of blades √ Full/Partial
2. Isolator (i) Mechanical operation √ Ok/Not Ok
(Sl. No.--- (ii) Remote Operation √ OK/Not OK
Make: (iii) Local Operation √ OK/Not OK
Capacity: (iv) Measurement of contact resistance
(v) Interlocking with earth switch √ OK/Not OK
(vi) Interlocking with Circuit Breaker √ OK/Not OK
(vii) IR Values Phase to Phase and Phase to
 Open condition Earth
 Closed condition M Ohm --- M Ohm
--- M Ohm --- M Ohm
3. Circuit Breaker (i) Rating of Circuit Breaker
(Circuit breaker  Type AB SWITCH
location and  Voltage 11 kV
no.)
 Normal Current 400 Amps
Circuit breaker
 Rupturing Current 36 kA
control circuits
(ii) IR Values Phase to Phase and Phase to
 Open condition Earth
 Closed Condition --- M Ohm --- M Ohm
--- M Ohm --- M Ohm
(iii) Contact Resistance including -------------micro ohm/NA√
Dynamic Contact Resistance
Measurement
(iv) Mechanical Operation √ Instant smooth
/time gap (Sec.)
(v) Remote operation √ OK/Not OK
8 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4]

(vi) Local Operation √ OK/Not OK

(vii) Interlocking with Isolator √ OK/Not OK
(viii) Interlocking with earth switch √ OK/Not OK
(ix) Alarm and Trip for OK/Not OK/NA√
OTI/WTI/Buchholz/PRV/etc.,
(x) Earth Fault Relay OK/Not OK/NA√
(xi) Over Current Relay OK/Not OK/NA√
(xii) Under Voltage Relay OK/Not OK/NA√
(xiii) other safety Alarms OK/Not OK/NA√
(xiv) Whether all the provisions of √ OK/Not OK
Regulation 37 are satisfactory?
4. Transformer (i) Insulation Resistance Values
Transformer No.,  HT to LT ABOVE 100MΩ
Location,  HT to Earth ABOVE 100MΩ
(Transformer Sl. No.  LT to Earth
ABOVE 100MΩ
Make, Capacity,
Voltage Ratio) (ii) Break down Voltage test
 Oil sample I (Top) 58.5 kV
 Oil Sample II (Bottom) 60 kV
(iii) Vector Group Test √ OK/Not OK
(iv) Polarity Tests √ OK/Not OK
(v) Magnetic Balance √ OK/Not OK
(vi) Tan Delta Test √ OK/Not OK
(vii) Oil level in conservator tank √ OK/Not OK
(viii) Oil level in breather cup √ OK/Not OK
0 0 0
(ix) OTI/WTI settings A/T--- C/--- C A/T--- C/---
0
C
(x) OTI/WTI alarm and trip operation OK/Not OK/NA√
(xi) Operation of Buchholz relay OK/Not OK/NA√
(xii) Operation of PRV OK/Not OK/NA√
(xiii) Oil leakage √ OK/Not OK
(xiv) Interlock of door switch of dry √ OK/Not OK
transformer
(xv) Clearances
 Side Clearance: 150 cm
 Between two Transformers: 5 Metre
(xvi) Body Earth Resistance 0.4 Ohm
(xvii) Neutral Earth Resistance N1-0.4 Ohm, N2-0.6 Ohm
(xviii) Earth Flat Size Material used
 Body: 50X6 MM
 Neutral: 50X6 MM
(xix) Operation of ON LOAD & OFF √ OK/Not OK
LOAD Tap Changers
(xx) Sweep Frequency Resonance OK/Not OK/NA√
Analysis Test (SFRA)
(xxi) Dielectric Frequency Resonance OK/Not OK/NA√
Analysis (DFRA) Test
(xxii) Partial Discharge Tests OK/Not OK/NA√
5 DG (i) Type of Generator
Generators: (ii) Interlocking with other supply OK/Not OK/NA√
Generator No.,
[ III— 4] 9

Location, sources
(Alternator and (iii) Body earth resistance ---------- Ohm/NA√
Engine Sl. No.
Make, Capacity) (iv) Neutral earth resistance N1---Ohm N2---Ohm/NA√
(v) Earth Flat Size, Material used
(Cu/Al) ------------------NA√
 Body:
------------------NA√
 Neutral:
(vi) Generator Protection details ------------------
6. Cable (i) Insulation Resistance Values:
(Details to be  Ph - Ph: 1.5 M Ohm
given: size, length,  Ph – Earth: 0.8 M Ohm
type)
 Ph – Earth + other Ph: 1.9M Ohm
(ii) Cable trays Provided/ Not provided√
(iii) Cable tray earthing OK/Not OK√
(iv) Cables bending radius OK/Not OK -----------metre√
7. Panels (i) No. of panels 1 Nos
(ii) Location of panel To be enclosed
(iii) Rating of the panel 200 Amp
(iv) Size and current rating of the main 25 X6 mm, 300 Amp
Bus bars and the distribution Bus
bars of the panel
(v) Whether the Bus bar size of the √ Yes/No
panel suitable to rating of the panel
(vi) IP Protection of panel YES√

(vii) Type of cable entry Top Entry/Bottom Entry/NA√

(viii)No. of Incomers and Bus couplers 1 Nos
in a Panel
(ix) Ratings of the Circuit Breakers 400 Amp
(x) No. of MCCBs of each rating in 400 AMP
the panel
(xi) No. of spare MCCBs of each rating NILL
(xii) Panel Clearance from the wall Mm/NA√
(xiii)Clearance between two panels i.e. Mm/NA√
adjacent panels
(xiv) Whether all the provisions of √ Yes / No
Regulation 39 followed
(xv) Size of the Earth strip used for 25 sqmm
earthing of the panel
8. Earthing (i) Metal and size of Earth Strips Cu/Al/GI√ --- Sqmm
(ii) Type of earthing Plate/Pipe√ /Counterpoise
(iii) Location and No. of earth electrode 5 Nos
(iv) Values of Earth resistance of each _0.2 Ω
earth electrode and Grid
(v) Earth mat resistance _Ω/NA√
9. Potential (i) Ratio test OK/not OK/ NA√
Transformer (ii) Polarity test OK/not OK/ NA√
(iii) BDV of oil ---------- kV/ NA√
(iv) IR test (R) P-E-------M Ohm/ NA√
10 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4]

(Y) P-E-------M Ohm/ NA√

(B) P-E-------M Ohm/ NA√
(v) Tan Delta and Capacitance NA√
measurement
10. Current Transformer (i) Ratio test OK/not OK NA√
(ii) Polarity test OK/not OK
(iii) BDV of oil ---------- kV
(iv) IR test (R) P-E-------M Ohm
NA√
(Y) P-E-------M Ohm
(B) P-E-------M Ohm
(v) Tan Delta and Capacitance
measurement
11. Overhead lines and (i) Size of the poles of DP structure PCC POLE 9 MTR LONG
DP structure (ii) Clearance between phases to phase YES √
and phase to earth.
(iii) Ground clearance of the YES √
conductors.
(iv) Check of electrical clearance along YES √
the route of overhead line,
(v) Check of guarding and clearance at Ok/ Not Ok/NA√
road crossings.
(vi) Check the footings of the poles. √ Ok/ Not Ok
(vii) Earthing arrangements √ Ok/ Not Ok
(viii)What is the minimum size of the 0.70 SQMM COVERDE
conductors of overhead lines used? CONDUCTOR
State the type of conductors.
(ix) Whether all the provisions of √ Yes / No
regulation 60, 62, 63, 64, 71, 72
and 74 are satisfied.
General Observations:
1. Check of phase to phase, phase to ground and sectional clearance YES √
2. Check of Manufacture test reports of individual equipment YES √
(Copies to be enclosed)
3. General observation and views (Specific deviation from the requirements of YES √
the Regulations shall be clearly brought out)

Date:
Signature of the supplier/ Owner / Consumer
Name
Designation
File No.
To: Office of Electrical Inspector for
………………...

(For Self-certification by supplier /owner

/consumer)
CERTIFICATE
[Under Regulation (32) and (45) of CEA (Measures relating to Safety & Electricity Supply) Regulation, 2023]
This is to certify that the electrical installation is complete in all respects and the work has been carried out
conforming to the CEA (Measures relating to Safety & Electric Supply) Regulation, 2023 and relevant standards. The
site tests done are found to be in order and it is electrically safe to operate the apparatus free from any danger.
Encl: Test reports
(Signature) (Signature)
[ III— 4] 11
Self-certifying supplier / owner / consumer Chartered Electrical Safety Engineer
Name
12 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4]
Name
[ III— 4] 13

Encl: Test reports

(Signature) (Signature)
Self-certifying supplier / owner / consumer Chartered Electrical Safety Engineer
Name
Name

File No.
To: Office of Electrical Inspector for
………………...
Forms of Inspection Report
[See sub-regulation (3) of regulation (32)]
FORM IV
(Electrical Installations in Mine)
Report No.: Date of Inspection:
Date of last inspection: Name of the Inspecting Officer:
1. Name of the
Mine:
2. Name of the
Owner:
3. Name of the
Agent:
4. Name of the Mine Manager:
5. Name of the Colliery Engineer:
6. Name of the Safety Officer:
7. Name of the designated Electrical Safety Officer:
8. Name of the Electrical Supervisor:
9. Name of the workman Inspector (Electrical) :
10. Name of the Engineer (concerned Section) :
11. Name of the working seam:
12. Working district Inspected:
13. Name of the persons accompanied during inspection:
14. Voltage and system of supply:
(i) Volts
(ii) No. of Phases
(iii)AC/DC
15. Particulars of the installations/ apparatus installed and their location as per mine plan:
16. Illumination level:
17. Percentage of methane/other explosive gas:
18. Dry bulb temperature, wet bulb temperature in case of underground mine:
19. Velocity/speed of air in case of underground mineL:
20. General conditions of the installation:
Sl. Regulation No. Requirements Report
No.
1. Regulation 98 On or before the first day of February in every year, notice in Yes/No
the form set out in Schedule IX or Schedule X whichever is
applicable is sent.
14 THE GAZETTE OF INDIA : EXTRAORDINARY [PART III—SEC.4]
2. Regulation 99 The plans specified under this regulation are kept in the office of Yes/No
the mine manager and available to the Inspector or inspector of