Certificate of Compliance with Healthcare Engineering Requirements

(***please select***) (Cap. 633)

Electrical installation

Section A

Information of the *** and service covered by the application:

***	:	Example: ABC Medical Centre
Service	:	Example: Surgical procedure, endoscopic procedure, anaesthetic procedure
Service Location	:	Example: Unit 1003, 10/F, DEF Commercial Centre, XXX Nathan Road, Mongkok, Kowloon, Hong Kong

Section B

I, as the licensee of the ***, declare that I have arranged a Registered Professional Engineer (R.P.E.) to certify in Section C that the electrical installation(s) for the critical care area(s) for the service described in Section A to be in compliance with the requirements in the ***, and I hereby warrant that the electrical installation(s) for the critical care area(s) comply with the requirements of the ***.

Name	:	Example: CHAN Tai Man
Post Title	:	Example: Chief Medical Executive
Signature	:
Date	:
Company Chop	:

Section C

I, as a Registered Professional Engineer (R.P.E.), certify that the electrical installation(s) for the critical care area(s) for the service described in Section A have been designed, installed and completed in compliance with the ***, and in accordance with the specified standards (namely Health Technical Memorandum (HTM) 06-01 (2017 edition) - Electrical services supply and distribution) and requirements described herewith.

Critical Care Area	Source of power supplies (N/E/U/B) and back-up time of back-up power supply (minute)	Isolated power supply for life critical medical device (Yes / Not applicable)
Critical medical equipment	Operating lamp	General lighting
Example: Operating Room 1	N / E(120) / U(30)	N / U(30)	N / E(120)	Yes
Example: Operating Room 2	N / E(120) / U(30)	N / U(30)	N / E(120)	Not applicable
Example: Recovery Area	N / U(30)	-	N / B(120)	Not applicable
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Section C (cont.)

The particulars of the electrical installation(s) are shown in the following schematic diagrams(s) and layout plan(s):

Drawing No.	Revision	Drawing Title
Example: EL/S/01	1	Main Electrical Schematic Diagram
Example: EL/S/02	0	UPS Schematic Diagram
Example: EL/S/03	0	IPS Schematic Diagram
Example: EL/S/04	2	MCB Detail Diagram
Example: EL/L/01	0	Electrical Layout Plan at 10/F
Example: EL/L/02	1	Electrical Layout Plan at OR No. 1, OR No. 2 and Recovery Area
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I also confirm that I have personally inspected the electrical installation(s) for the critical care area(s) covered by this certificate and the results of the inspection are satisfactory.

Name	:	Example: LEE Chi Nan
R.P.E. Number	:	Example: RPE123456
Discipline	:	Please select
Signature	:
Date	:

Sources of power supply can be multiple. For example, power supply to an item equipped with normal power, emergency generator and uninterruptible power supply can be represented as “N/E/U”.

N : Normal power supply; E : Emergency generator; U : Uninterruptible power supply(UPS);
B : Internal battery of operating lamp / general lighting

A Registered Professional Engineer (R.P.E.) certifying an electrical installation shall be registered in the electrical discipline or building services discipline with the Engineers Registration Board under the Engineers Registration Ordinance (Cap. 409).