Portable Heater Extension Cord Safety Checklist Form
Use this checklist to confirm safe operation of a portable heater with an extension cord. Complete all items to ensure compliance with safety standards.
Inspector Name
*
First Name
Last Name
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspection Location
*
Is the portable heater in good working condition (no visible damage, manufacturer instructions followed)?
*
Yes
No
Is the extension cord rated for the heater's power requirements and free from damage?
*
Yes
No
Is the outlet used for the extension cord properly grounded and free from signs of overheating?
*
Yes
No
Is the extension cord placed to avoid tripping hazards, pinching, or running under rugs or furniture?
*
Yes
No
Is the heater kept away from flammable materials (curtains, papers, furniture, etc.)?
*
Yes
No
Is the heater plugged directly into the extension cord (not daisy-chained or connected with other appliances)?
*
Yes
No
Additional Comments or Observations
Submit Checklist
Should be Empty: