7/5/23, 11:24 AM Electrical Safety Inspection Report - SafetyCulture
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
Client / Site
Location
Conducted on
Competent Person
Description of work
Electrical Equipment
When electrical equipment or lines are to be serviced, maintained, or adjusted, are
necessary switches opened, locked out or tagged, whenever possible?
Yes No N/A
https://public-library.safetyculture.io/products/electrical-safety-inspection-report?amp_dev=2b1f9dd3-af25-46d8-9bd2-a4abbac9e1b2&sid=168853… 1/8
7/5/23, 11:24 AM Electrical Safety Inspection Report - SafetyCulture
Are portable electrical tools and equipment grounded or of the double insulated type?
Yes No N/A
Are electrical appliances such as vacuum cleaners, polishers, vending machines, etc.,
grounded?
Yes No N/A
Do extension cords have a grounding conductor?
Yes No N/A
Are multiple plug adapters prohibited?
Yes No N/A
Are ground-fault circuit interrupters installed on each temporary 15 or 20 ampere, 120
volt alternating current (AC) circuit at locations where construction, demolition,
modifications, alterations, or excavations are being performed?
Yes No N/A
Are all temporary circuits protected by suitable disconnecting switches or plug
connectors at the junction with permanent wiring?
Yes No N/A
Are electrical installations not in hazardous dust or vapor areas?
Yes No N/A
Are exposed wiring and cords with frayed or deteriorated insulation repaired or
replaced promptly?
Yes No N/A
https://public-library.safetyculture.io/products/electrical-safety-inspection-report?amp_dev=2b1f9dd3-af25-46d8-9bd2-a4abbac9e1b2&sid=168853… 2/8
7/5/23, 11:24 AM Electrical Safety Inspection Report - SafetyCulture
REFERENCE: Electrical wires in good working condition
[This is an example of how you can use iAuditor to include best practice reference
images in your templates to assist with inspections]
Are flexible cords and cables free of splices or taps?
Yes No N/A
Are clamps or other securing means provided on flexible cords or cables at plugs,
receptacles, tools, equipment, etc., and is the cord jacket securely held in place?
Yes No N/A
Are all cord, cable and raceway connections intact and secure?
Yes No N/A
In wet or damp locations, are electrical tools and equipment appropriate for the use or
location or otherwise protected?
Yes No N/A
Is the location of electrical power lines and cables (overhead, underground, under floor,
other side of walls, etc.) determined before digging, drilling, or similar work is begun?
Yes No N/A
Are metal measuring tapes, ropes, hand-lines or similar devices with metallic thread
woven into the fabric prohibited where they could come in contact with energized parts
of equipment or circuit conductors?
Yes No N/A
https://public-library.safetyculture.io/products/electrical-safety-inspection-report?amp_dev=2b1f9dd3-af25-46d8-9bd2-a4abbac9e1b2&sid=168853… 3/8
7/5/23, 11:24 AM Electrical Safety Inspection Report - SafetyCulture
Is the use of metal ladders prohibited where the ladder or the person using the ladder
could come in contact with energized parts of equipment, fixtures, or circuit conductors?
Yes No N/A
Are all disconnecting switches and circuit breakers labeled to indicate their use or
equipment served?
Yes No N/A
Are disconnecting means always opened before fuses are replaced?
Yes No N/A
Do all interior wiring systems include provisions for grounding metal parts of electrical
raceways, equipment and enclosures?
Yes No N/A
Are all electrical raceways and enclosures securely fastened in place?
Yes No N/A
Are all energized parts of electrical circuits and equipment guarded against accidental
contact by approved cabinets or enclosures?
Yes No N/A
Is sufficient access and working space provided and maintained around all electrical
equipment to permit ready and safe operations and maintenance?
Yes No N/A
https://public-library.safetyculture.io/products/electrical-safety-inspection-report?amp_dev=2b1f9dd3-af25-46d8-9bd2-a4abbac9e1b2&sid=168853… 4/8
7/5/23, 11:24 AM Electrical Safety Inspection Report - SafetyCulture
Are all unused openings (including conduit knockouts) in electrical enclosures and
fittings closed with appropriate covers, plugs, or plates?
Yes No N/A
Are electrical enclosures such as switches, receptacles, junction boxes, etc., provided
with tight-fitting covers or plates?
Yes No N/A
Are disconnecting switches for electrical motors in excess of two horsepower able to
open the circuit when the motor is stalled without exploding? (Switches must be
horsepower rated equal to or in excess of the motor rating.)
Yes No N/A
Is low voltage protection provided in the control device of motors driving machines or
equipment that could cause injury from inadvertent starting?
Yes No N/A
Is each motor disconnecting switch or circuit breaker located within sight of the motor
control device?
Yes No N/A
Is each motor located within sight of its controller or is the controller disconnecting
means able to be locked open or is a separate disconnecting means installed in the
circuit within sight of the motor?
Yes No N/A
Is the controller for each motor that exceeds two horsepower rated equal to or above
the rating of the motor it serves?
Yes No N/A
https://public-library.safetyculture.io/products/electrical-safety-inspection-report?amp_dev=2b1f9dd3-af25-46d8-9bd2-a4abbac9e1b2&sid=168853… 5/8
7/5/23, 11:24 AM Electrical Safety Inspection Report - SafetyCulture
Employees
Are all employees required to report any obvious hazard to life or property in connection
with electrical equipment or lines as soon as possible?
Yes No N/A
Are employees instructed to make preliminary inspections and/or appropriate tests to
determine conditions before starting work on electrical equipment or lines?
Yes No N/A
Are employees who regularly work on or around energized electrical equipment or lines
instructed in cardiopulmonary resuscitation (CPR)?
Yes No N/A
Are employees prohibited from working alone on energized lines or equipment over 600
volts?
Yes No N/A
Lockout Procedures
Are proper lock-out, tag-out and testing completed to ensure the voltage is off before
performing maintenance on electrical equipment?
Yes No N/A
Are multiple locking devices used when more than one person works on a piece of
equipment so workers can all apply their own lock?
Yes No N/A
https://public-library.safetyculture.io/products/electrical-safety-inspection-report?amp_dev=2b1f9dd3-af25-46d8-9bd2-a4abbac9e1b2&sid=168853… 6/8
7/5/23, 11:24 AM Electrical Safety Inspection Report - SafetyCulture
If there is a question about the safe operation of an electrical tool or piece of
equipment, is it removed from service, tagged and repaired by a qualified technician?
Yes No N/A
Are there written lock-out procedures provided for anyone performing lock-out
procedures, including contractors?
Yes No N/A
Is proper lock-out and tag-out equipment available that has only one key per lock?
Yes No N/A
Are authorized workers trained in proper lock-out procedures when performing
maintenance on electrical equipment?
Yes No N/A
Do supervisors ensure proper lock-out procedures are followed?
Yes No N/A
Overall Assessment and Recommendations
Overall assessment of the workplace
Safe At Risk
Enter recommendations here
Completion
Full Name and Signature of Inspector
https://public-library.safetyculture.io/products/electrical-safety-inspection-report?amp_dev=2b1f9dd3-af25-46d8-9bd2-a4abbac9e1b2&sid=168853… 7/8
7/5/23, 11:24 AM Electrical Safety Inspection Report - SafetyCulture
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.
https://public-library.safetyculture.io/products/electrical-safety-inspection-report?amp_dev=2b1f9dd3-af25-46d8-9bd2-a4abbac9e1b2&sid=168853… 8/8
