Low Voltage Circuit Assessment Form
Complete this form to evaluate the safety, compliance, and performance of a low voltage circuit.
Assessor Name
*
First Name
Last Name
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Project or Circuit Reference
*
Circuit Voltage Level
*
Please Select
12V DC
24V DC
48V DC
120V AC
Other
General Condition of Wiring
*
1
2
3
4
5
Are all components properly labeled?
*
Yes
No
Partially
Safety Compliance (e.g., insulation, enclosure, grounding)
*
Rows
Not Compliant
Partially Compliant
Fully Compliant
Insulation
1
2
3
Enclosure
4
5
6
Grounding
7
8
9
Cable Management
10
11
12
Component Quality (e.g., connectors, relays, fuses)
*
Rows
Poor
Fair
Good
Excellent
Connectors
13
14
15
16
Relays
17
18
19
20
Fuses
21
22
23
24
Switches
25
26
27
28
Functional Testing Results
*
Pass
Fail
Not Tested
Additional Comments or Observations
Submit Assessment
Should be Empty: