Electrical Safety Checklist Form

Inspector Full Name*

First NameLast Name

Inspection Date*

Date

Location of Inspection*

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Are all electrical panels properly labeled?*

YesNoNot Applicable

Are all cords and plugs in good condition?*

YesNoNot Applicable

Are circuit breakers functioning correctly?*

YesNoNot Applicable

Are grounding systems properly installed?*

YesNoNot Applicable

Are emergency shutoff switches accessible and operational?*

YesNoNot Applicable

Are there any exposed wires or damaged insulation?*

YesNoNot Applicable

Additional comments or observations*

Inspector Signature*