Title Page
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Document No.
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Inspection Numbers are to be entered in the following format with all digits resetting each day and new days beginning with 001: YYYY-MM-DD-###
Example: The third inspection conducted on December 8, 2015 would be 2015-12-08-003 -
Location
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Provide Building Name, Municipal Address, Department, All Room #s.
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Conducted on
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Date and Time will be automatically generated by the program according to the date and time set by the iPad by selecting today then save under the green date tab on the right.
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Conducted By
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Please select the primary inspector for the report.
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Department Members Present During Inspection
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Please enter the names and positions of all department/workgroup members present during the inspection.
Extension Cords
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Are there any extensions cords in use as permanent fixtures?
Extension Cord as Permanent Fixture Violation
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Room number or area
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Photograph each cord in the department individually.
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Are there any extension cords that are rated for outdoor use only?
Outdoor Use Only Extension Cord Violation
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Room number or area
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Photograph each cord in the department individually.
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Are there any extension cords that currently present a tripping hazard?
Outdoor Use Only Extension Cord Violation
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Room number or area
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Photograph each cord in the department individually.
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Unplug and remove all offending cords that will not immediately impact projects or research. Example remove all that are not attached to research refrigerators or other research equipment that is currently running.
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Please enter the locations of all extension cords that were immediately unplugged and removed during the inspection.
Power Bars
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Are there any appliances plugged into power bars?
Appliances Plugged Into Power Bars Violation
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Room number or area
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Photograph each occurrence in the department individually.
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Are there any power bars that appear to be overloaded or plugged into another power bar(octopus style setup)?
Overloaded or Octopus Style Power Bar Violation
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Room number or area
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Photograph each occurrence in the department individually.
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Are there any power bars that currently present a tripping hazard?
Power Bar Tripping Hazard Violation
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Room number or area
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Photograph each cord in the department individually.
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Unplug and remove all offending cords that will not immediately impact projects or research. Example remove all that are not attached to research refrigerators or other research equipment that is currently running.
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Please enter the locations of all extension cords that were immediately unplugged and removed during the inspection.
