Dark Field Inspection Checklist Form
Complete this form to document and assess all required items during a dark field inspection.
Inspection Reference Number
*
Inspection Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Inspector Name
*
First Name
Last Name
Inspection Location or Equipment
*
Checklist: Visual Cleanliness
*
Pass
Fail
Not Applicable
Checklist: Surface Defects Detected
*
None
Minor
Major
Checklist: Illumination Adequacy
*
Adequate
Marginal
Inadequate
Severity Rating of Findings
*
None
1
2
3
4
Severe
5
1 is None, 5 is Severe
Observations and Notes
Corrective Actions Required
Submit Inspection
Should be Empty: