Title Page

  • Conducted on

  • Client

  • Address
  • Prepared By

  • Location of Camera

  • CCTV Reference Number


  • Is the camera lens focused and adjusted properly?

  • Has the camera been knocked off?

  • Is the property perimeter clearly displayed?

  • Is the camera lens free from dust and marks?

  • Are the motion detection sensors working?

  • Do all camera functions such as zoom and pan work correctly?

  • Is there no foliage obscuring the view?

  • Are cameras securely attached to the wall?

Wire and Cable

  • Are wirings free from any wear and tear or exposed wires?

  • Are there no loose wires?

  • Is the cable dressed properly?

  • Is the transmission of sound clear and picture with no distortion?

  • Are all coaxial connectors insulated from conduit and pull boxes?

Control Equipment

  • Are the monitors showing clear picture? brightness and contrast settings correctly adjusted?

  • Are all of your switches and individual equipment fully functioning?

  • Are all monitors and equipment free from dust and grime?

  • Are all cables leading from the equipment in good condition? No weak connections?

  • Is the time and date stamp correctly set?

  • Are all power connections and AC plugs not loose and in good working condition?


  • Any other physical defects found?

  • Take photo (optional)

Focus Area

  • Recommendation (take note of blind spots)


  • Inspected by (Full Name and Signature)

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.