Electrical Service Termination Checklist Form
Document and track all steps required for safe and complete electrical service shutoff or termination.
Site or Location Name
*
Date of Service Termination
*
-
Month
-
Day
Year
Date
Name of Responsible Person
*
First Name
Last Name
Reason for Service Termination
*
Please Select
Scheduled Maintenance
Decommissioning Facility
Customer Request
Emergency Shutdown
Other
Pre-Termination Safety Inspection Completed
*
Yes
No
Not Applicable
Main Electrical Equipment Powered Down
*
Yes
No
Not Applicable
Final Meter Reading (if applicable)
Stakeholders Notified of Termination
*
Yes
No
Final Walkthrough/Inspection Completed
*
Yes
No
Additional Notes or Comments
Submit Checklist
Should be Empty: