Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

Device details

  • Manufacturer

  • Model

  • Serial number

  • Drawing reference

  • Name plate

Visual Inspection

  • Clean & tidy

  • Rodent activity

Functional Test

  • IR Test Required

  • Tester make/model

  • Tester serial

  • Insulation Resistance
  • IR test connection

  • Voltage (kV)

  • Duration (min)

  • DAR

  • PI

  • IR (G ohm)

  • Ratio test required

  • Tester make/model

  • Tester serial

  • Ratio test
  • Injection

  • Measurement

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.