Electrical Safety Check
Electrical Inspection Form
1
Job & Customer Information
Job Number
Customer Name
Customer Location
Today's Date
Age Of Home
How Many Years Have You Lived In The Home?
Do You Have Any Concerns With Your Electrical System At This Time?
Yes
No
If we find anything that deserves your attention, is it okay that we show it to you?
Yes
No
2
Electrical Safety Inspection
Take your time and meticulously fill out this safety check form. Upload pictures of your gauges and testing instruments for the customer's file. Remember, the customer is paying us to save them time and money. We are able to accomplish that by finding small issues before they become big costly issues. Be as detailed as required and upload pictures for the customer's peace of mind.
3
Panel #1
Panel
Circuit Breakers UL Listed for panel?
Yes
No
Burn or hot spots on breakers?
Yes
No
Is there oxidation?
Yes
No
Are any breakers double tapped?
Yes
No
Any hot or burn spots on busbar?
Yes
No
Ground system condition?
Select…
Good
Fair
Poor
Needs Attention
Any code issues?
Yes
No
Any water penetration?
Yes
No
Are breaker sizes correct for wire size?
Yes
No
Are any breakers excessively hot?
Yes
No
Is the panel obsolete?
Yes
No
Are ARC-Fault breakers installed per code?
Yes
No
Are GFCI breakers installed per code?
Yes
No
Is the panel over-filled with circuits?
Yes
No
Panel Pictures — Add Pictures
Take Photo
Add Pictures
4
Receptacles & Switches
Are the devices worn out?
Yes
No
Spot check for burn spots on receptacles & switches
Yes
No
Do the devices have stab in wires?
Yes
No
Is the grounding correct on the devices?
Yes
No
Does the homeowner have any concerns about the devices?
Yes
No
Receptacles & Switches Pictures — Add Pictures
Take Photo
Add Pictures
5
Surge Protection
Is adequate whole panel surge protection provided?
Yes
No
Is the existing surge protector operational?
Yes
No
Do expensive appliances and equipment have adequate surge protection?
Yes
No
Is the ground system adequate to work in conjunction with the surge protector?
Yes
No
Surge Protection Pictures — Add Pictures
Take Photo
Add Pictures
6
Main Panel Information
Enter The Main Panel Information Below
Manufacturer
Age
Model
Size In Amps
Type
Select…
Breaker
Fuse
Other
Main Panel Pictures — Upload Pictures
Take Photo
Add Pictures
7
GFCI Receptacles
Are GFCI's fully operational?
Yes
No
Are GFCI's in code required locations?
Yes
No
8
Lighting Fixtures & Fans
Is the lighting adequate for the customer?
Yes
No
Are the lights & fans in good functioning order?
Yes
No
Does the customer need any outdoor security lighting?
Yes
No
Lighting Fixtures & Fans Pictures — Add Pictures
Take Photo
Add Pictures
Additional Lighting / Fixture Notes
9
Smoke Detectors & Carbon Monoxide
Are the smoke detectors under 10 years?
Yes
No
Are the smoke detectors fully functional?
Yes
No
Are smoke detectors and carbon monoxide detectors in the correct locations?
Yes
No
Did you test all smoke and carbon monoxide detectors for full and proper functionality?
Yes
No
10
Diagnoses And Recommendations
Write Your Diagnoses Here
Write Your Recommendations Here
11
Authorization
Customer Signature
Sign here
Clear
Technician Signature
Sign here
Clear
Submit Inspection
