Title Page
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Account Number
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Conducted on
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Prepared by
Inspection & Maintenance Form for Pad-Mounted Equipment
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Account Number
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Members Name
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Substation
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Feeder
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Phase
Type of Equipment:
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Transformer
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Manufacturer
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Serial Number
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KVA Size
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1 Phase
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3 Phase
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Riser Pole
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Condition
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Conduit
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Cutouts
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Standoff
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Arrestors
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Warning Sign
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Junction Cabinet
Foundation Type:
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Box Pad
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Flat Poly Pad
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Concrete Pad
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Condition
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Grade
Exterior Marking:
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"Warning" Decal
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Location Number
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Other Specify
Exterior:
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Condition
- Ok
- Fading-No Corrosion
- Corroding
- Corroding - Beyond Repair
- Needs Painting
- Needs Repair
- Needs Replacing
Oil Filled Equipment:
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Condition
- Ok
- Minor Leak
- Needs Repair or Replaced
- Major Leak - Needs to be repaired or replaced immediately
- Repaired
Equipment Security: Items not checked as "Yes" should be repaired immediately
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Secured to Foundation
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Pentahead Bolt Present & Secured
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Hasp & Pad or other lock installed
Interior Markings:
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"Danger" Decal
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Cable Labels
Terminations: Enter Quantities
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Elbows
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Condition
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Parking Stand & Cap
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Condition
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Secondary Connections & Insulation
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Condition
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Feed Through In Use
Grounds: Including
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Bleeder Wire
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Ground Rod
Surge Arresters:
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Existing
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Connections
Animals/Insect Nests:
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Condition
Other:
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List any obstructions (Fences, Trees, Shrubs, Buildings, ETC.)
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Please note any other problems, actions taken or needed
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Photo
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Inspected By: