Templates
Equipment Inspection Form Template

Equipment Inspection Form Template

An equipment inspection form template documents the condition of your equipment. It provides a report of needed repairs to make sure everything is up and running

Use this template
or download pdf
Equipment Inspection Form Template

An equipment inspection form template documents the condition of your equipment. It provides a report of needed repairs to make sure everything is up and running

Use this template
or download pdf

About the Equipment Inspection Form Template

Use this free Equipment Inspection Form Template to assess the condition of equipment, usually after a risk assessment has been conducted.

Categories

  • Maintenance templates
  • Workplace safety templates
Preview of the template
Information
Facility and Room number
Owner (name and badge number)
Center / Office name
Equipment Name and Description of Function
Manufacturer
Model Number
Serial Number
Equipment Status
Listing Status
Operating Environment
External Inspection
Enclosure
Operator not exposed to any hazard
Not damaged
Appropriate material
Protects contents from operating environment
Will contain any arcs, sparks, electrical explosions
Power Source (Cord and Plug)
Voltage
Not frayed or damaged
Proper voltage, frequency, phasing, and ampacity rating for the plug and cord
Proper loading and over current protection and/or equipment branch circuit
Proper wiring of plug
Installation according to NEC
Connected to facility power with appropriate adaptors
Power Source (Direct Wired into Facility)
Proper voltage, phasing, frequency, and ampacity rating for the plug and cord
Voltage
Installation according to NEC
Proper loading and over current protection and/or equipment branch circuit
Grounding
All non-current carrying exposed metals is properly bonded and grounded (ground continuity test: less than 1 ohm to ground pin/conductor):
Ground conductor included if required
Marking and documentation
Power requirements marked (current, voltage, frequency)
Hazard marked, including stored energy
Internal Inspection
Internal Wiring
Polarity correct
Phasing correct
Landing of ground correct
All non-current carrying internal subsystems are properly bonded
Wiring terminal and leads working
Wire sizes adequate
Proper dielectric
Listed conductors, if applicable
Other internal issues founded
Neat workmanship
Listed components used
Proper management of conductors
Free of sharp edges
Adequate cooling
No debris
Automatic discharge of high voltage capacitors
Other Examination
Secondary Hazards: created by this equipment
rf hazards
Sub rf hazards
DC electric or magnetics fields
IR, visible or UV
X-rays
Fire, electrical explosion
Are workers protected from hazards
Test of internal components
Any evidence of failed components
After testing of components, did any parts fail or had evidence of failure
Approval Section
Approved equipment will be installed and used in accordance with the instruction provided by the designer/builder and ESO
Attachments
Result
This equipment has been inspected and the condition at the time of inspections is noted in this report.
Contact
Inspector
Date and Time
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This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.