Conveyor Belt X-Ray Inspection Checklist Form
Complete this checklist to document and verify conveyor belt x-ray inspection tasks.
Inspector Name
*
First Name
Last Name
Inspection Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Conveyor Belt ID or Location
*
Is the x-ray machine operational and calibrated?
*
Yes
No
N/A
Are all safety shields and warning signs in place and visible?
*
Yes
No
N/A
Are there any signs of wear, damage, or contamination on the conveyor belt?
*
Yes
No
N/A
Is the x-ray image quality clear and free from obstructions?
*
Yes
No
N/A
Were all safety procedures followed during inspection?
*
Yes
No
N/A
Additional Comments or Observations
Inspection Completion Confirmation
*
Inspection Complete
Inspection Incomplete
Submit Checklist
Should be Empty: