Phase Monitoring Device Inspection Form
Complete this form to document the inspection and operational status of the phase monitoring device.
Device Serial Number
*
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector Name
*
Device Location
*
Phase Sequence Status
*
Correct
Incorrect
Power Phase Presence (L1, L2, L3)
*
L1 Present
L2 Present
L3 Present
Indicator Lights Status
*
Power LED On
Fault LED On
Relay LED On
Relay Operation
*
Normal
Not Operating
Intermittent
Measured Voltage Values (L1-L2, L2-L3, L3-L1)
*
Rows
Voltage (V)
L1-L2
L2-L3
L3-L1
Comments / Observations
Final Assessment
*
Pass
Fail
Submit Inspection
Should be Empty: