Induction Motor Predictive Maintenance Checklist Form
Document your predictive maintenance inspection for induction motors with this concise checklist.
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Motor Identification Number
*
Inspector Name
*
First Name
Last Name
Operating Condition at Time of Inspection
*
Please Select
Running
Idle
Stopped
Visual Inspection (signs of wear, leaks, or damage)
*
No issues found
Wear detected
Leaks present
Other (specify in comments)
Vibration Level Check
*
Normal
Above Normal
Requires Attention
Temperature Check
*
Within range
Slightly elevated
High (requires attention)
Bearing Lubrication Status
Adequate
Needs lubrication
Not applicable
Electrical Connections Check
Secure
Loose (requires attention)
Additional Comments or Observations
Submit Checklist
Should be Empty: