Test and Tag

• Conducted on

  Date

• Prepared by

• Location
  Address

General

• Are all appliances in the area tagged?

  YES

  NO

• Photo of incorrect tag

  Media

• Evidence of testing compliance.

  Media

• Are any domestic leads or adapters being used?

  YES

  NO

• Photo of item

  Media

• Equipment number

• Are there any obvious defects present?

  YES

  NO

• Photos of defects.

  Media

• Have all identified defects been recorded? Attach defect report

  YES

  NO

• Evidence of last entry.

• Have all test and tag results been recorded? Attach test results if completed.

  YES

  NO

Completion

• Do all items pass

  YES

  NO

• List defects

• Recommendations

• Date of inspection

  Date

• Position

  Electrical Supervisor

  Supervisor

  Manager

  Superintendent

  Other

• Person Completing Inspection

  Sign