FORM A – 56 (3) For work completed under Office Use Only
Section 56 (3) of the Electrical Safety Act 2002. Service Order No
Ergon Energy will rely on the information provided by the Electrical NMI No.
Mechanic on this form as being provided on behalf of the customer. Date Received
Request for Initial Connection, Metering Change or Service Alteration
Electricity Act and Electricity Regulation 2006 and Electrical Safety Act and Regulation 2002
Use BLOCK LETTERS and indicate in appropriate boxes eg with a cross X. Fields marked with * are mandatory For Assistance see guidelines
Customer Details Request Details
*Name (Business Trading Name if applicable): *Date Work Ready for Connection / /
Appointment required Date: Time:
Supply Connection: O/H U/G
*Customer’s Retailer: Property Pole: Yes No
*Address of Electrical Installation (Location of Job) Meter Location: Outdoor Indoor
Unit /Shop No.: Lot No.: Plan No. (RP/SP): Main Switchboard Location: Outdoor Indoor
Street No.: Street: No. of Phases: 1 2 3
Locality: Postcode: Existing Meter Number:
Other directions to assist in locating address Distribution Services Fee
Charge Customer Charge Contractor
Nearest Cross Street: Other Request Comments
Other information:
*Reason for Request *Metering Required HV LV Unmetered
Initial Connection Permanent Temporary Builders Service Whole Current CT Photovoltaic
Meter Wiring changes Reseal Meter Meter Change Additional Embedded (net) Dedicated (gross)
Other Service Upgrade Point of Attachment Relocation Single Phase Poly Phase CT Ratio
2
Customer’s Mains Cable Size: mm Single rate Two rate No of meters
Maximum Demand: Amps/Phase No Relay 1 channel 2 Channel 3 Channel
Additional Information about request (eg Network availability, Pillar Uprate, additional phases required, Controlled Load - Off peak 8hrs 18 hrs
indication if reseal of meter or relay only is required i.e. no other work carried out, etc)
Un-metered Load Type:
Items being connected as Controlled Load
*Work Performed under Section 56 (3) (a) (1) of Electrical Safety Act 2002 and Tested By (please print details of Electrical Mechanic)
Electrical Mechanic Name: Address:
Electrical Workers Licence No.:
Phone / Mobile No.: ( ) Fax No.: ( ) Relationship to owner/occupier:
Certification (by Person Authorised Under the Electrical Safety Act 2002 to Perform and Test the Electrical Work)
I certify that I am authorised under the Electrical Safety Act 2002 (Qld) to perform electrical work and to connect the electrical installation on which I have
performed electrical work to a source of electricity.
I also state that the electrical installation will be completed in accordance with the requirements of the Electrical Safety Regulation 2002 (Qld), that tests
will be carried out in the way required under part 8 of the Electricity Safety Regulation 2002 (Qld) and that the electrical installation will be electrically safe
and ready for connection by the date work ready for connection stated above.
Note - If outgoing circuits are connected they must be tested.
Signature Date / /
Tariff type meter wiring installed
Domestic (11) Night rate - Super Economy (31) Demand LV - Time of use (43) Irrigation - Other (66)
General Supply (20) Controlled Supply–Economy (33) Demand HV - Time dependent (53) Other (Details to be provided below)
General Supply (21) Non-domestic heating–Time of use (37) Farm - time of use (62)
General Supply -Time of use (22) Demand LV - General supply (41) Irrigation – time of use (65)
Check this is the latest Process Zone version before use. Page 1 of 2 Form CS000500F111 Ver 2
Ergon Energy Corporation Limited ABN 50 087 646 062
Ergon Energy Queensland Pty Ltd ABN 11 121 177 802
FORM A – 56 (3) For work completed under
Section 56 (3) of the Electrical Safety Act 2002.
Ergon Energy will rely on the information provided by the Electrical
Mechanic on this form as being provided on behalf of the customer.
Guidelines - Request for Initial Connection, Metering Change or Service Alteration
For work completed under Section 56 (3) of the Electrical Safety Act 2002
(i.e. Not as an electrical contractor)
Information and guidelines regarding completing Request for Initial Connection, Metering Change or Service Alteration Form
• This form is only to be used when the work has been completed by an electrical mechanic on their own installation or that of a close relative under
Section 56 (3) of the Electrical Safety Act 2002. It is not to be used by an electrical contractor.
• Please use a black pen and print in legible block letters
• The following mandatory information must be provided:
(a) Sufficient detail to identify the customer and to locate the premises and metering position on site. Note – In the address section
“Locality” heading refers to the city suburb, town, or local area in rural locations.
(b) Details of the connection and metering arrangements and/or requirements.
(c) Supply requirements (e.g. metering, No of Phases, etc) and network availability.
(d) Details of the Electrical Mechanic responsible for, and who tested the work. Note – If outgoing circuits are connected they must
have been tested.
• If a specific appointment time is required on the date that the work is ready for connection, this needs to be arranged directly with the local depot,
please indicate and Ergon Energy will contact you back to arrange a time - e.g. for a point of attachment change requiring electrical contractor to be
on site.
• Unmetered connection of load will only be permitted where the load type meets the relevant legislation and rules. These loads must be miniscule in
nature and have a predictable load pattern. Details are available from Ergon Energy.
• Service connection support brackets and steel service poles must have a minimum rating of 1kN for 25mm services or 3.5 kN for 50 and 95 mm
services. Timber service poles must have a minimum rating of 5 kN. (Refer to Ergon Energy Customer Connection and Metering Manual).
• If sufficient information is not provided, the Form will be returned unactioned.
• Illegible and mutilated forms will not be accepted.
• Customer’s retailer must be made aware of any alterations or additions.
• The Certification statement must be completed (Signed) by the Electrical Mechanic making the certification.
How to Lodge a Completed Form
This form should be delivered to or faxed to an authorised receiving Ergon Energy depot.
Enquiries
Ergon Energy
General Customer Service: New Applications, Point of Attachment Site Visits, Breaking Meter Seals – All Areas...... 13 10 46
Faults: - All Areas …… 13 22 96
Other Information
Notified Pricing Information can be found on the DME website http://www.energy.qld.gov.au/franchise_electricity_prices.cfm
Notified Pricing Information can be found on the DME website http://www.energy.qld.gov.au
Ergon Energy will rely on the information provided by the Electrical Mechanic on this form as being provided on behalf of the customer.
Check this is the latest Process Zone version before use. Page 2 of 2 Form CS000500F111 Ver 2
Ergon Energy Corporation Limited ABN 50 087 646 062
Ergon Energy Queensland Pty Ltd ABN 11 121 177 802
