Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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1. LOCATION / SUBDIVISION:
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2. NAME / DATE OF INSPECTOR:
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3. TRANSFORMER SERIAL #:
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4. TRANSFORMER ID #:
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5. MAP INSIDE: (YES OR NO)
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6. MANUFACTURER NAME:
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7. KVA:
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8. IMP#
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9. TRANSFORMER TYPE:
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SINGLE PHASE
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3 PHASE
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DEADEND
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OPEN
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10. MAP INSIDE:
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YES
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NO
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11. DOUBLE TRANSWELL:
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YES
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NO
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12. ARRESTOR:
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YES
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NO
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13. VOLTAGE:
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14. PAD LOCK
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YES
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NO
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NEW
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15. PROBLEMS:
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ANTS
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MICE
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LEVEL
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OTHER (PLEASE DESCRIBE)
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16. OPEN CONCENTRIC WIRE
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YES
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NO
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17. OIL LEAK
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YES
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NO
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18. STICKERS:
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GOOD
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REPLACED
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NEEDED (DESCRIBE STICKER NEEDED)
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19. PRIMARY TAGED
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YES
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NO
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20. SECONDARY TAGED
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YES
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NO
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21. FOLLOW UP NEEDED ON THIS TRANSFORMER:
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YES (PLEASE DESCRIBE)
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NO
