Poultry X-Ray Inspection Checklist Form
Complete this checklist to document the results of a poultry X-ray inspection. Select the appropriate assessment for each item below.
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector Name
*
Equipment Operational Status
*
Operational
Requires Maintenance
Not Operational
Image Quality Assessment
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Calibration Check
*
Pass
Fail
Foreign Object Detection
*
None Detected
Detected
Corrective Actions Required
*
Yes
No
Inspection Points Assessment
Rows
Pass
Fail
N/A
Shielding in place
1
2
3
Warning signs posted
4
5
6
System interlocks functional
7
8
9
Additional Comments
Submit Checklist
Should be Empty: