Electrical Safety Compliance Assessment Checklist Form
Complete this Electrical Safety Compliance Assessment Checklist to ensure all required safety measures are in place and compliant.
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessor Name
*
First Name
Last Name
Site/Facility Name
*
Location/Area Inspected
*
Are all electrical panels and circuit breakers clearly labeled?
*
Yes
No
Not Applicable
Are emergency shutoff switches accessible and clearly marked?
*
Yes
No
Not Applicable
Are all power cords and extension leads in good condition (no fraying, exposed wires, or damage)?
*
Yes
No
Not Applicable
Are electrical outlets, switches, and fixtures securely mounted and free from defects?
*
Yes
No
Not Applicable
Is appropriate signage (warning, caution) displayed near electrical hazards?
*
Yes
No
Not Applicable
Comments or Observations
Submit Assessment
Should be Empty: