Equipment Functional Test Checklist
Document and verify the operational status of equipment with this systematic checklist.
Equipment Information
Please provide details about the equipment being tested.
Equipment Name/Type
*
Equipment ID/Serial Number
*
Location of Equipment
*
Date and Time of Test
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Name of Person Conducting Test
*
First Name
Last Name
Pre-Test Visual Inspection
*
Passed
Failed
Not Applicable
Functional Test Items
*
Rows
Pass
Fail
Not Applicable
Power On/Off
1
2
3
Control Panel Response
4
5
6
Safety Features
7
8
9
Indicators/Lights
10
11
12
Operational Sound
13
14
15
Connectivity/Communication
16
17
18
Accessories Attached
19
20
21
Rate Overall Equipment Condition
*
1
2
3
4
5
Observations / Issues Noted
Corrective Actions Taken (if any)
Name of Reviewer/Approver
First Name
Last Name
Submit Checklist
Should be Empty: