Maintenance Check Testing Log Form
Record and verify details of maintenance checks, testing activities, and results for equipment or systems.
Date and Time of Maintenance Check
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Equipment/Asset Name or ID
*
Location of Equipment
*
Type of Maintenance Activity
*
Please Select
Routine Inspection
Preventive Maintenance
Corrective Maintenance
Testing Only
Other
Checklist of Maintenance Tasks
*
Rows
Completed
Not Applicable
Visual Inspection
1
2
Lubrication
3
4
Parts Replacement
5
6
Calibration
7
8
Safety Check
9
10
Cleaning
11
12
Test Results
*
Pass
Fail
Not Applicable
Observations or Issues Found
Actions Taken or Recommendations
Name of Person Performing Maintenance
*
First Name
Last Name
Supervisor or Witness Name (if applicable)
First Name
Last Name
Signature of Responsible Person
*
Submit Log
Submit Log
Should be Empty: