Equipment Recertification Checklist Form
Complete this checklist to assess equipment readiness for recertification.
Equipment Name or ID
*
Equipment Type
*
Equipment Location
*
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current Equipment Status
*
Operational
Requires Maintenance
Out of Service
Inspection Checklist
*
Rows
Pass
Fail
N/A
Physical Condition
1
2
3
Safety Devices Functional
4
5
6
Calibration Status
7
8
9
Warning Labels Intact
10
11
12
Power Supply Check
13
14
15
Details of Issues Found (if any)
Actions Required
Next Recertification Due Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector Name
*
First Name
Last Name
Inspector Signature
*
Additional Comments
Submit Checklist
Submit Checklist
Should be Empty: