Utility Inspector Equipment Assessment Form
Evaluate the condition, completeness, and readiness of utility inspector equipment.
Inspector Name
*
First Name
Last Name
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Equipment List Assessment
*
Rows
Present
Condition
Safety Vest
1
Excellent
Good
Fair
Poor
Needs Replacement
Hard Hat
2
Excellent
Good
Fair
Poor
Needs Replacement
Insulated Gloves
3
Excellent
Good
Fair
Poor
Needs Replacement
Voltage Detector
4
Excellent
Good
Fair
Poor
Needs Replacement
Flashlight
5
Excellent
Good
Fair
Poor
Needs Replacement
First Aid Kit
6
Excellent
Good
Fair
Poor
Needs Replacement
Are all required equipment items available?
*
Yes
No
Overall Equipment Condition
*
1
2
3
4
5
Are any items due for maintenance or replacement?
*
Yes
No
Is the equipment ready for service?
*
Yes
No
Comments or Notes
Submit Assessment
Should be Empty: