Checkweigher Legal-for-Trade Verification Form
Use this form to record equipment details, verification setup, test results, and final verification outcome for a checkweigher.
Equipment Identification
Equipment Name / Model
*
Manufacturer
*
Serial Number or Asset Tag
*
Location / Site
*
Department / Line
*
Verification Date / Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Verification and Test Setup
Verification Type
*
Initial
Routine
After Maintenance
After Relocation
Other
Scale Capacity / Range
*
Division / Readability
Environmental Conditions
Normal
Draft
Vibration
Temperature Concern
Other
Test Standard / Fixture Used
*
Legal-for-Trade Test Results
Legal-for-Trade Check Results
*
Rows
Nominal Value
Observed Value
Pass/Fail
Remarks
Zero Check
Repeatability
Accuracy at Low Test Weight
Accuracy at Mid Test Weight
Accuracy at High Test Weight
Reject Function
Display Stability
Tolerance / Acceptance Result
Overall Result
*
Please Select
Pass
Fail
Conditional Pass
Comments for Fail or Conditional Pass
Zero Check Nominal Value
Repeatability Observed Value
Low Test Weight Observed Value
High Test Weight Observed Value
Inspector and Follow-up
Inspector / Operator Name
*
First Name
Last Name
Role / Title
*
Calibration / Maintenance Reference
Corrective Actions Needed
Re-test Required?
*
Yes
No
Next Verification Due Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Verification
Should be Empty: