Fiber Optic LC Connector Termination Checklist Form
Document and verify LC fiber optic connector termination work with this comprehensive checklist.
Work Order or Project Reference
*
Fiber Type
*
Please Select
Singlemode
Multimode OM1
Multimode OM2
Multimode OM3
Multimode OM4
Other
Connector Type
*
Please Select
LC/UPC
LC/APC
Other
Termination Method
*
Epoxy and Polish
Pre-polished/Mechanical
Fusion Splice-On
Other
Visual Inspection Result
*
Pass - No Defects Observed
Fail - Defects Present
End Face Cleanliness
*
Clean
Dirty
Cleaned During Process
Insertion Loss Test Result (dB)
*
Any Issues Found?
*
No Issues
Yes (Describe Below)
Corrective Action Taken (if any)
Technician Name and Date
*
Submit Checklist
Should be Empty: