BUSINESS CONTACT INFORMATION

Name:	Date:
Company Name:	Phone No.:
Email:	Application No.:
Registered Company Address City, Province, Postal Code

Inspection location

Name of Location:
Address:
Phone:
Email:

EQUIPMENT information

Equipment	Manufacturer	Serial #	Model #	Quantity

Please attach any drawings and shop drawings of equipment

Special Instructions

Field Evaluation of Electrical Equipment Service Agreement

The following agreement is in accordance with CSA-SPE-1000-13, model code for the field evaluation of electrical equipment and will not supersede any previous evaluations conducted by a certification organization or re-evaluation of any equipment that has been rejected.

To be qualified for a field evaluation, your equipment must meet one of the following criteria: custom-built equipment for special applications, equipment manufactured on a non-repetitive basis, equipment sold in quantities of less than 500 on a national basis, per model, per year, per inspection body, equipment not obtainable as “Certified” under a regular certification program, equipment already installed or ready for use on-site and awaiting acceptance be the AHJ, complete systems or subassemblies that are all available for examination and testing during the evaluation process and other electrical equipment as determined by the AHJ. Please consult an AHJ for clarity on qualification requirements for inspection.

All products and installations shall be inspected individually and in accordance with all codes and standards. All information pertaining to this inspection shall be held confidential to Vision and its clients

This inspection does not supersede any authority having jurisdiction (municipal, provincial and/or federal). Any disputes between the client and IB shall be appealed through the standards council of Canada and they will have the final level of appeal.

Any documentation or reports shall be available if requested by the Standards Council of Canada or any authority having jurisdiction.

This inspection shall be in accordance with. CSA SPE-1000-13 Model Code for the field evaluation of electrical equipment and the specific requirements of the Canadian Electrical Code, Part 1. We ensure our inspectors have examined all equipment requested and will verify all serial numbers on all equipment.

If any product or installation that is bearing an inspection label is deemed as a potential hazard you shall inform Vision immediately and we shall take the appropriate corrective action. Clients are required to take corrective actions if a product is found to be non-conformant or hazardous.

Vision Integrity will not be held liable for any costs incurred if any product proves to be hazardous.

Client	Vision Representative

Signature	Signature
Name and Title	Name and Title
Date	Date