Diesel Transfer Pump Inspection Checklist Form
Complete this checklist to document the inspection and condition of the diesel transfer pump and its components.
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector Name
*
First Name
Last Name
Pump ID or Serial Number
*
Pump Operational Status
*
Operational
Needs Maintenance
Out of Service
Visible Leaks or Damage
*
None
Minor
Major
Electrical Connections Condition
*
Good
Loose
Damaged
Hose Condition
*
Good
Worn
Leaking
Filter Status
*
Clean
Needs Replacement
Safety Devices Functional
*
Yes
No
Overall Inspection Result
*
Pass
Fail
Requires Follow-up
Submit Inspection
Should be Empty: