Phase Monitoring Relay Inspection Checklist Form
Use this form to document inspection details, checklist results, phase monitoring observations, and follow-up actions for a relay inspection.
Inspection Overview
Inspector Name
*
First Name
Last Name
Inspector Role / Department
*
Inspection Date
*
-
Month
-
Day
Year
Date
Inspection Time
*
Hour Minutes
AM
PM
AM/PM Option
Site / Facility Name
*
Asset / Equipment ID
*
Asset Location
*
Relay Type / Model
*
Please Select
Electromechanical Relay
Static Relay
Digital Relay
Numerical Relay
Other
Phase Monitoring Relay Checklist
General Condition
*
Pass
Fail
Needs Attention
Not Applicable
Wiring and Terminal Condition
*
Pass
Fail
Needs Attention
Not Applicable
Enclosure Condition
*
Pass
Fail
Needs Attention
Not Applicable
Indicator and Status Lights
*
Pass
Fail
Needs Attention
Not Applicable
Signs of Overheating
*
None Observed
Minor Concern
Major Concern
Not Applicable
Dust, Moisture, or Corrosion
*
Pass
Fail
Needs Attention
Not Applicable
Labeling and Markings
*
Pass
Fail
Needs Attention
Not Applicable
Secure Mounting
*
Pass
Fail
Needs Attention
Not Applicable
Test Observations and Fault Findings
Observed phase sequence status
*
Normal
Incorrect
Not Tested
Other
Relay response status
*
Responsive
Delayed
No Response
Not Tested
Other
Alarms or trips observed
Alarm
Trip
Warning
None
Other
Faults, deviations, and supporting notes
Overall inspection result
*
Please Select
Pass
Conditional Pass
Fail
Corrective Actions and Follow-Up
Recommended Corrective Actions
*
Required Parts or Work Order Reference
Urgency / Priority Level
*
Please Select
Low
Medium
High
Critical
Responsible Technician / Team
*
Target Follow-Up Date
*
-
Month
-
Day
Year
Date
Completion Status
*
Open
In Progress
Closed
Submit Inspection
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