Title Page

  • Conducted on

  • Prepared by

  • Location

Reviewed Department

  • Which department are you reviewing?

Electrical

  • All equipment is shut-down and unplugged at end of day?

  • Are panel box breakers labeled clearly?

  • Are any electrical panels or disconnect switches blocked?

  • All electrical appliances are rated for industrial use (fans, cords, power strips, ...)?

  • Are flexible cords running over sprinkler piping, under doors, through walls, through ceilings, or through windows?

  • All opening in electrical panels and boxes closed (knock outs, breaker openings, ...)?

  • Do any extension cords have damage?

  • Are extension cords stored properly when not in use?

  • Is there any loose or broken electrical conduit?

  • Are lockouts used on light switches while home is energized?

Signature

  • Supervisor's Signature

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