Maintenance Technician Equipment Assessment Form
Evaluate equipment condition during maintenance inspections using this assessment form.
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Technician Name
*
Equipment ID or Name
*
Overall Equipment Condition
*
1
2
3
4
5
Is the equipment operating as expected?
*
Yes
No
Partially
Assessment Checklist
*
Rows
Pass
Attention Needed
Fail
Physical Condition
1
2
3
Safety Features
4
5
6
Lubrication
7
8
9
Electrical/Power Supply
10
11
12
Control Systems
13
14
15
List any issues identified
Actions Taken/Repairs Performed
Recommendations for Future Maintenance
Next Scheduled Maintenance Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Assessment
Should be Empty: