Extension Cord Safety Checklist
Complete this checklist to ensure extension cords are safe for use and meet safety standards.
Inspector Full Name
*
First Name
Last Name
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspection Location (Room, Area, or Site)
*
Extension Cord Safety Checks (Mark all that apply)
*
Cord is free from cuts, cracks, or abrasions
Plug and connectors are intact and undamaged
Cord is not spliced, taped, or repaired improperly
Cord is rated for the intended load/use
No exposed wires are visible
Cord is not running through doorways, windows, or under carpets
Cord is properly stored when not in use
Other (please specify)
Is the extension cord approved for outdoor use (if applicable)?
*
Yes
No
Not applicable
Additional Comments or Observations
Submit Checklist
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