Emergency Response Equipment Checklist Form
Document the inspection and readiness of emergency response equipment using the Emergency Response Equipment Checklist Form.
Inspector Name
*
First Name
Last Name
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Equipment Type
*
Please Select
Fire Extinguisher
First Aid Kit
Defibrillator (AED)
Emergency Lighting
Spill Kit
Rescue Tools
Other
Equipment ID or Location
*
Physical Condition
*
Excellent
Good
Fair
Poor
Operational Status
*
Operational
Requires Maintenance
Out of Service
Checklist of Required Items
*
Equipment is clean and free of damage
All parts and accessories present
Expiry dates checked (where applicable)
Signage and instructions visible
Seals and security tags intact
Maintenance Actions Needed
*
No action required
Replace parts/accessories
Clean equipment
Update signage/instructions
Other (please specify below)
Additional Comments or Notes
Task Completion Confirmation
*
All inspection tasks completed
Some tasks incomplete (see comments)
Submit Inspection
Should be Empty: