Go digital today!

Convert your paper checklists into digital forms

Scan this QR code to use this paper checklist on your smartphone or
tablet or visit https://safetyculture.com/

Title Page

Conducted on 

Client

Address 

Prepared By

Location of Camera

CCTV Reference Number

Camera

Is the camera lens focused and adjusted properly?

Yes No N/A
 Has the camera been knocked off?

No Yes N/A

Is the property perimeter clearly displayed?

Yes No N/A

Is the camera lens free from dust and marks?

Yes No N/A

Are the motion detection sensors working?

Yes No N/A

Do all camera functions such as zoom and pan work correctly?

Yes No N/A

Is there no foliage obscuring the view?

Yes No N/A

Are cameras securely attached to the wall?

Yes No N/A

Wire and Cable

Are wirings free from any wear and tear or exposed wires?

Yes No N/A
 Are there no loose wires?

Yes No N/A

Is the cable dressed properly?

Yes No N/A

Is the transmission of sound clear and picture with no distortion?

Yes No N/A

Are all coaxial connectors insulated from conduit and pull boxes?

Yes No N/A

Control Equipment

Are the monitors showing clear picture? brightness and contrast settings correctly
adjusted?

Yes No N/A

Are all of your switches and individual equipment fully functioning?

Yes No N/A

Are all monitors and equipment free from dust and grime?

Yes No N/A

Are all cables leading from the equipment in good condition? No weak connections?

Yes No N/A
 Is the time and date stamp correctly set?

Yes No N/A

Are all power connections and AC plugs not loose and in good working condition?

Yes No N/A

Defects

Any other physical defects found?

Take photo (optional) 

Focus Area

Recommendation (take note of blind spots)

Completion

Inspected by (Full Name and Signature) 

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's
solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice.
You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should
independently determine whether the template is suitable for your circumstances.