Electric IR Assessment

• Document No.

• Client

• Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

SITE INFORMATION

• PICTURE IDENTIFYING LOCATION

  Media

• WHO CURRENTLY DOES INFRARED INSPECTION?

  No one

  Corporate Managed

  Contracted

  in-House

• CONTACT INFORMATION FOR IR PROGRAM MANAGER

• DOES FACILITY HAVE SHUTDOWN PERIODS?

  yes

  no

• DATES SHUTDOWNS OCCUR

• HAVE THEY IDENTIFIED WHEN/HOW THEY PLAN TO INSTALL?

OVERALL EQUIPMENT INFORMATION

• PICTURE OF ASSET, NAMEPLATE LABEL, ARC FLASH LABEL

  Media

• NOTES

• Do you need more fields?

  yes

  no

• PICTURE OF ASSET, NAMEPLATE LABEL, ARC FLASH LABEL

  Media

• NOTES

• Do you need more fields?

  yes

  no

• PICTURE OF ASSET, NAMEPLATE LABEL, ARC FLASH LABEL

  Media

• NOTES

• Do you need more fields?

  yes

  no

• PICTURE OF ASSET, NAMEPLATE LABEL, ARC FLASH LABEL

  Media

• NOTES

• Do you need more fields?

  yes

  no

• PICTURE OF ASSET, NAMEPLATE LABEL, ARC FLASH LABEL

  Media

• NOTES

• Do you need more fields?

  yes

  no

• PICTURE OF ASSET, NAMEPLATE LABEL, ARC FLASH LABEL

  Media

• NOTES

• Do you need more fields?

  yes

  no

• PICTURE OF ASSET, NAMEPLATE LABEL, ARC FLASH LABEL

  Media

• NOTES

• Do you need more fields?

  yes

  no

• PICTURE OF ASSET, NAMEPLATE LABEL, ARC FLASH LABEL

  Media

• NOTES

• Do you need more fields?

  yes

  no

• PICTURE OF ASSET, NAMEPLATE LABEL, ARC FLASH LABEL

  Media

• NOTES

• Any additional notes