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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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