EMERGENCY LIGHTING COMPLETION CERTIFICATE For small installations and verification of existing installations

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A DETAILS OF THE CLIENT Client/ B DETAILS OF THE EMERGENCY LIGHTING INSTALLATION Extent of the installation covered by this certificate The Owner 19 Walker Grove, Hatfield, Hertfordshire 19 Walker Grove, Hatfield, Hertfordshire 4x emergency lights and 2x test switches only This certificate is not valid if the serial number has been defaced or altered Postcode Issued in accordance with BS 5266-1, by an Approved Contractor or Conforming Body enrolled with NICEIC, Warwick House, Houghton Hall Park, Houghton Regis, Dunstable LU5 5ZX. AL10 9PL Postcode AL10 9PL C PURPOSE OF CERTIFICATE Verification of existing installation or Small installation work The installed work is: D DETAILS OF THE ORGANISATION RESPONSIBLE FOR CERTIFICATION/VERIFICATION* New An addition An alteration (*delete as appropriate) Trading title L R H Contractors 9 Grove Meadows, Welwyn Garden City NICEIC Enrolment No (Essential information) 5 0 0 1 7 6 Postcode AL7 2BE Branch number (if applicable) 0 0 0 E DECLARATION OF CONFORMITY In consequence of acceptance of the outcomes declared in Section H of this certificate, I/we* hereby declare that the emergency lighting system installation, or part thereof, described in Section B of this certificate conforms, to the best of my/our* knowledge and belief, to the appropriate recommendations and requirements given in BS 5266-1: 2011, Emergency lighting Part 1: Code of practice for the emergency lighting of premises, BS EN 1838: 2013 Lighting applications Emergency lighting and BS EN 50172: 2004, Emergency escape lighting systems, as set out in the outcomes declared in Section H, except for the deviations recorded in Section I. To be signed by either: a) The Responsible Person / Competent Person (England and Wales); b) The Employer or Other Persons (Scotland) or c) The Employer or Nominated Employee (Northern Ireland) Signature Date 07/08/2015 F VALIDITY REVIEW AND ESSENTIAL RELATED DOCUMENTS This certificate is valid only when accompanied by current versions of all the following: i) Signed compliance checklist (see Section H) ii) Photometric design data (see note 1) iii) Test log book The contractor issuing this certificate MUST sign to verify that i), ii) and iii) above have been supplied with this certificate and that all essential related reference documents have been recorded below. Related documents Insert the relevant certificate and design schedule numbers. (Insert if not applicable). Electrical Installation Certificate No. (see Note 2) DPN5/00512213 Design Schedule No(s) Minor Electrical Installation Works Certificate No. Other documents In addition to the above, details of other related documents (if any), should be recorded below. Emergency Lighting Periodic Inspection and Test Certificate No. (see Note 3) Signed by the NICEIC Approved Contractor Reviewed by the Qualified Supervisor Signature Date 07/08/2015 Signature Date 07/08/2015 G NEXT INSPECTION 1 year We, the signatories shown in Sections E and F, RECOMMEND that this installation is further inspected and tested after an interval of not more than Notes: 1. This can be in any of the following formats (in all cases appropriate de-rating factors must be used), and identified to meet worst case requirements: a) Authenticated spacing data such as ICEL 1001 registered tables; b) calculations as detailed in CIBSE / SLL Guide LG12; c) appropriate electronic format of results. 2. The electrical safety aspects of the emergency lighting installation must also be certified in accordance with BS 7671 Requirements for Electrical Installations by issuing an Electrical Installation Certificate or, where appropriate, a Minor Electrical Installation Works Certificate. 3. Where this certificate relates to an alteration or addition that necessitated the carrying out of a periodic inspection on the existing emergency lighting installation, the Emergency Lighting Periodic Inspection and Testing Page 1 of 3 Certificate should accompany this certificate. This form is based on the model in Annex G of BS 5266-1: 2011 ESN2C/1

NOTES FOR RECIPIENT THIS CERTIFICATE IS AN IMPORTANT AND VALUABLE DOCUMENT AND SHOULD BE RETAINED FOR FUTURE REFERENCE Only the NICEIC Approved Contractor or Conforming Body responsible for the small emergency lighting installation work, or the verification of an existing emergency lighting installation, is authorised to issue this NICEIC Emergency Lighting Completion Certificate. This certificate has a printed seven digit serial number which is traceable to the Approved Contractor to which it was supplied by NICEIC. You should have received the certificate, consisting of 3 pages in total, marked Original, and the NICEIC Approved Contractor responsible for carrying out the work should have retained the certificate marked Duplicate. This certificate should have been issued for one of two purposes: the certification of new emergency lighting installation work that includes no more than 25 new emergency lighting luminaires, or the verification of an existing emergency lighting installation of any size, as indicated in Section C of the certificate. Further information in relation to both of these purposes is given below. Certification of emergency lighting installation works Where used for this purpose, this certificate should have been issued on completion of new emergency lighting installation work that includes no more than 25 new emergency lighting luminaires, where the NICEIC Approved Contractor issuing the certificate is solely responsible for the design, construction and the inspection and testing of the work. The work may be either a new emergency lighting installation or an addition or alteration to an existing emergency lighting installation. The completed certificate is intended to confirm that the emergency lighting installation, detailed in Section B of the certificate has been fully inspected and tested and, except for the deviations (if any) recorded in Section I of the certificate, complies with the requirements of BS 7671: 2008 Requirements for Electrical Installations, (IET Wiring Regulations Seventeenth Edition, as amended) and the relevant recommendations and requirements of the emergency lighting standards listed below: BS 5266-1: 2011 Emergency lighting Part 1: Code of practice for the emergency escape lighting of premises, and BS EN 1838: 2013 Lighting applications Emergency lighting, and BS EN 50172: 2004 (BS 5266-8: 2004) Emergency escape lighting systems. Verification of an existing emergency lighting installation Where used for this purpose, the certificate verifies an existing emergency lighting installation (generally one installed to a previous edition of BS 5266-1) in circumstances where a valid completion certificate is not available, for compliance with the current versions of the standards listed above. The certificate should not have been issued for the periodic inspection and testing of an existing emergency lighting installation, for which an Emergency Lighting Periodic Inspection and Testing Certificate should be used. The completed certificate should have been issued to the Responsible Person (England and Wales), Employer or Nominated Person (Scotland) or the Employer or Appropriate Person (Northern Ireland) for the premises and must be accompanied by all the following documents: i) a completed and signed compliance checklist ii) iii) photometric design data an appropriate test log book The absence of any of these documents (i, ii or iii) above renders this certificate invalid. * NICEIC, is operated by Certsure LLP, a partnership between the Electrical Contractors Association and the charity, the Electrical Safety Council. NICEIC maintains and publishes registers of electrical contractors that it has assessed against particular scheme requirements (including the technical standard of electrical work). For further information about electrical safety and how NICEIC can help you, visit www.niceic.com ESN2C/1&2

H COMPLIANCE CHECKLIST Clause No. Items assessed for compliance This form is based on the model in Annex G of BS 5266: Part 1: 2011 SYSTEM DESIGN AND DOCUMENTS 4.2 1 Accurate plans are available showing the location of all emergency escape routes, the emergency exits, test facilities, fire indicating and fire fighting equipment and the like 5 2 Adequate illumination* is provided under test conditions, for safe movement on escape routes (1 lux minimum on the centre line) and in open areas (0.5 lux minimum) 5.1.3 3 For existing installations where authenticated spacing data is unavailable, satisfactory estimates are attached and acceptable 6 4 Design provides coverage for all areas identified by the fire safety risk assessment 6 5 Design provides coverage for all hazards identified by the fire safety risk assessment 9.1 6 System is designed for the correct emergency duration period 9.2 7 System has the correct mode of operation 11 8 Photometric data accompanies this certificate 11 9 A test log book accompanies this certificate and is up-to-date EMERGENCY LUMINAIRES 5 10 Luminaires are suitably spaced in accordance with authenticated spacing or design data 6.1 11 Non-maintained luminaires operate on failure of supply to local lighting circuit 6.3 12 Illumination from at least two luminaires provided in each compartment of an escape route and open area 6.4 13 Luminaires are mounted at least 2 m above the floor and at a suitable height/position to avoid areas of smoke accumulation and/or obstructions 6.6 14 Luminaires are sited at or near (within 2 m) all relevant points of emphasis in accordance with BS 5266-1: 2011 and in positions/locations identified from the fire safety risk assessment 6.6 15 Luminaires are installed where necessary to cover toilets, lifts, plant rooms and the like 6.7 16 Luminaires are suitably protected for their location (IP rating) 6.7 17 All luminaires and converted luminaires conform to BS EN 60598-2-22 12 18 Luminaires and lamps are in good condition 12.3 19 Luminaires have been tested and found to operate for their full rated duration 12.3 20 After the system has been tested, each luminaire charging indicator operates correctly SAFETY SIGNS 5.4.2 21 All emergency escape route signs and emergency exit signs are adequately illuminated when the normal lighting is extinguished 5.4.3 22 Safety signs, such as fire fighting equipment location signs and other safety signs, are identified during the fire safety risk assessment, are adequately illuminated when the normal lighting is extinguished TEST FACILITIES 8.3.3 23 A sufficient number of suitably located test facilities are provided 8.3.3 24 All test facilities are suitable to apply a test for the relevant duration 8.3.3 25 The test facilities act upon the intended luminaires only 8.3.3 26 Automatic test facilities conform to IEC 62034 10.7 27 Instructions on the use of the test facilities and recording the results of tests have been given to the user(s) WIRING/EQUIPMENT 8 28 Fixed wiring of the emergency lighting installation has been installed in accordance with BS 7671: 2008 (as amended) 8.2.1 29 Cables of a centrally supplied system adequately resist the effects of fire 8.2.1 30 Cables of a centrally supplied system are adequately protected against mechanical damage 8.2.3 31 Cables of a centrally supplied system are adequately supported using non-combustible supports/fixings 8.2.6 32 All the cables of a centrally supplied system are segregated from other supplies, including those of other safety services 8.2.7 33 Conductors of the emergency lighting installation are adequately sized 8.2.12 34 Connection plugs and sockets are protected against unauthorised use 8.3.2 35 Isolators, switches protective devices and test facilities of the emergency system are appropriately labelled 8.3.5 36 The central power supply unit conforms to BS EN 50171 8.3.5 37 The central power supply is compatible with the supply voltage range of the luminaires, taking into account supply cable voltage drop FINAL DECLARATION TO BE CONDUCTED AT COMPLETION 10.7 38 User has been provided with accurate system documentation (drawings layout plans) 10.7 39 Deviations (if any) have been recorded accurately 10.7 40 User has been made aware of the action they need to take in the event of a test failure 10.7 41 The user has been made aware of the need to maintain an up-to-date test log book 11 42 Photometric data has been supplied to the user 12.3 43 The emergency lighting system operates correctly when tested Assessment carried out by: This declaration is not valid if the serial number has been defaced or altered Notes: Indicates that an item was assessed and the declared outcome was satisfactory. Indicates that an item was assessed and a deviation was identified. Indicates that the assessment of an item was not applicable to the particular installation. Where a declared outcome is identified by an, the details of the deviation must be accurately recorded in Section I. Where the deviation relates to a new emergency lighting installation, or new work associated with an addition or alteration to an existing installation, the deviation must be agreed between the signatories of Section E and Section F Signature Date 07/08/2015 * Illumination is normally checked by visual inspection and from the design spacings. Where measurements are taken the results and details of the instrument used (including serial number) must be appended with this certificate. Declared outcome Page 2 of 3 ESN2C/3 ESN2/3

Where the original photometric design data is unavailable for an existing installation, substitute evidence (obtained from manufacturers of emergency luminaires) may be used to provide estimated values of illumination. In such circumstances all relevant calculations and data should be appended to the completed certificate. If you were the person ordering the work, but not the user of the installation, you should pass this certificate, or a full copy of it, including these notes and any related reference documents, to the user immediately. This certificate should be retained in a safe place and be shown to any person inspecting or undertaking further work on the emergency lighting installation in the future. If you later vacate the premises, the certificate will demonstrate to the new user that the emergency lighting installation covered by this certificate complied with the standards listed above and the requirements of BS 7671: 2008 (as amended), at the time the certificate was issued. For safety reasons, the emergency lighting installation will need to be inspected and tested at appropriate intervals by a competent person. The recommended interval before the next inspection and test, on the work covered by this certificate, should have been agreed between the NICEIC Approved Contractor and the person signing Section E and entered into Section G of the certificate. NICEIC Approved Contractors have been assessed as having the technical capability to carry out electrical work in compliance with the national electrical safety standard, BS 7671. The scope of that standard includes electrical safety aspects of emergency lighting systems but does not extend to the operational performance of such systems. Consequently, NICEIC is unable to investigate complaints about the operational performance of emergency lighting systems. Where the client/person ordering the work has reason to believe that the newly installed work does not comply with the requirements of the national electrical safety standard, BS 7671: 2008 (as amended), or the particular electrical safety aspects embodied in the other standards included on the certificate, the client should, in the first instance, raise their specific concerns in writing with the Approved Contractor. If those concerns remain unresolved, the client may make a formal complaint to NICEIC. The complaints procedure offered by NICEIC is subject to certain terms and conditions, full details of which are available on the NICEIC website. ESN2C/3&4

I DEVIATIONS This This certificate declaration is not is not valid valid if the if the serial serial number has has been been defaced or or altered altered Record the details of all deviations identified in Section H. For a deviation identified during the verification of an existing installation, state the recommended action. Where no deviations are identified in Section H record NONE under Deviations below. Item No. Deviations Recommended action J COMMENTS ON EXISTING INSTALLATION (Any defects identified on the existing emergency lighting installation, not covered by this certificate, should be recorded below) This form is based on the model in Annex G of BS 5266: Part 1: 2011 Page 3 of 3 ESN2C/5 ESN2/5