KD-PTW-EI-011 · Electrical safety documents

Electrical Isolation Certificate — fillable PDF

1 page. 74 fields. Fillable in Adobe Reader, Preview, Chrome, or on a phone.

The isolation record behind the Electrical Permit to Work — made, proved, locked and tagged.

The legal basis, cited on the form

• HSE HSG250 (isolation certificates as separate documents)
• PUWER 1998 reg 19

What it is not

It is not a completed document and it is not health and safety advice. You must adapt it to your site and have a competent person complete and issue it. See why we don't say "compliant".

Format

AcroForm fillable PDF. Every field has a tooltip. Tab order follows the reading order. Works on desktop and mobile, in Adobe and non-Adobe readers.

This revision was prepared against legislation current at 2026-08-07. Revision R01.0. Check kubitdocs.com/revisions for the current revision before use.