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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.

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Equipment Inspection Form 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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Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.