Inspection Mirror Usage Checklist
Complete this checklist to document inspection mirror use and operational completion in the field.
Inspector Name
*
First Name
Last Name
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspection Location
*
Inspection Mirror Condition (before use)
*
Good
Needs Cleaning
Damaged
Pre-Use Functionality Check Completed?
*
Yes
No
Inspection Area(s) Covered
*
Any Obstructions or Issues Found?
*
None
Obstructions Present
Other Issues
Details of Findings (if any)
Inspection Mirror Condition (after use)
*
Good
Needs Cleaning
Damaged
Additional Comments
Submit Checklist
Should be Empty: