Extension Cord Power Switch Inspection Form
Please complete this form to document the inspection of an extension cord power switch.
Inspector Name
*
First Name
Last Name
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspection Location
*
Extension Cord Condition
*
Good
Fair
Poor
Power Switch Operation
*
Operates Normally
Intermittent
Does Not Operate
Visible Damage
*
None
Cracked Housing
Exposed Wires
Burn Marks
Other
Grounding Pin Present
*
Yes
No
Proper Labeling
*
Yes
No
Corrective Action Required
*
Yes
No
Inspector Comments
Submit Inspection
Should be Empty: