Title Page

  • Inspection Number

  • Equipment Type

  • Department

  • Conducted on

  • Tester

  • Location
  • Foreman +Crew Members

Equipment Information

  • Equipment Type (Bucket, digger, liner, pole saw etc.)

  • Manufacturer

  • Unit #

  • Model #

  • Serial #

  • Category (A,B,C)

  • Humidity Level at time of test

Test Data

  • Date and time of actual testing

  • Upper Boom Tested at 56kv

  • Leakage in Micro amps

  • Reject

  • Pass or Fail

  • Lower Insert Tested at 56kv

  • Leakage in Micro Amps

  • Reject

  • Pass or Fail

  • Bucket Liner #1 Tested at 100kv

  • Pass or Fail

  • Bucket Liner #2 Tested at 100kv

  • Pass or Fail

  • Testing Decal Applied?

  • Comments:

  • Tester Signature

  • Operators Signature

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