Electrical Preventive Maintenance Checklist Form
Complete this form to ensure your electrical systems are properly maintained and safe.
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector Name
*
First Name
Last Name
Equipment or Area Inspected
*
Equipment ID
Location or Area
Inspection Time
Hour Minutes
AM
PM
AM/PM Option
Follow-up Required?
Yes
No
Maintenance Tasks
*
Check for loose or damaged wiring
Inspect circuit breakers and panels
Test safety switches and emergency stops
Verify grounding and bonding connections
Check lighting fixtures and replace bulbs
Other
Comments or Findings
Inspector Signature
Submit Checklist
Submit Checklist
Should be Empty: