Pipeline Inspection Camera Assessment Form
Evaluate the performance and field readiness of your pipeline inspection camera using this streamlined assessment form.
Camera Model / Serial Number
*
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Overall Camera Image Quality
*
1
2
3
4
5
Camera Operational Status
*
Fully operational
Minor issues (does not impact use)
Major issues (impacts use)
Not operational
Field Readiness Checklist
*
Rows
Pass
Needs Attention
Fail
Battery/Power Supply
1
2
3
Cable/Reel Condition
4
5
6
Control Unit Functionality
7
8
9
Monitor/Display Clarity
10
11
12
Evaluate the following features
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Accessories Present and Functional
Carrying case
Cleaning kit
Spare cable
Other
Notes or Recommendations
Final Assessment
*
Ready for field use
Ready with minor issues
Not ready – requires service
Submit Assessment
Should be Empty: