Extension Cord Inspection Tag Log
Use this form to document the inspection of extension cords for safety, compliance, and maintenance records.
Cord Tag or Asset Number
*
Location of Cord
*
Date and Time of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Inspector Full Name
*
First Name
Last Name
Cord Length (in feet or meters)
*
Cord Type
*
Please Select
Heavy Duty
Medium Duty
Light Duty
Other
Cord Rating (Amps/Volts)
*
Inspection Checklist
*
Rows
Pass
Fail
Cable intact, no cuts or abrasions
1
2
Plug and connectors in good condition
3
4
No exposed wires
5
6
Ground pin present (if applicable)
7
8
Cord properly tagged and labeled
9
10
Inspection Result
*
Pass
Fail
Corrective Actions Taken (if any)
Upload Photo of Cord or Tag (optional)
Upload a File
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Additional Comments or Notes
Inspector Signature
*
Submit Inspection Log
Submit Inspection Log
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