Utility Asset Inspection Checklist Form
Use this form to record a utility asset inspection, document condition and hazards, and note any required follow-up actions.
Asset Identification
Asset ID or Asset Name
*
Asset Type / Category
*
Please Select
Pole
Transformer
Meter
Valve
Pipe
Switchgear
Hydrant
Other
Site / Location
*
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspection Details
Overall Condition
*
Poor
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Poor, 10 is Excellent
Visible Damage Present
Yes
Leaks, Corrosion, or Cracks Observed
Leaks
Corrosion
Cracks
Safety Hazards Observed
Trip Hazard
Exposed Wiring
Loose Components
Other
Functionality Verified
Operational Check Passed
Controls Responding
No Issues Found
Inspector and Follow-up
Inspector Name
*
First Name
Last Name
Follow-up Action Required
*
Monitor
Repair
Replace
Escalate
No Action
Recommended Next Steps
Submit Inspection
Should be Empty: