Electrical Cord Inspection
Project Name: Date:
Name of Inspector: Time:
Employee ID: Shop #:
Cord Inspection Cord 1 2 3 4 5
Cord Length
American Wire Gauge size of cord (example - 14 - 12 - 10)
Do extension cords have a grounding conductor/third prong? Y / N Y / N Y / N Y / N Y / N
Are cords with frayed, nicked or deteriorated insulation replaced promptly? Y / N Y / N Y / N Y / N Y / N
Are cords rated for extra hard use? Example: type SO, SJO, SJTW insulation
rating. Y / N Y / N Y / N Y / N Y / N
Are male/female caps securely fastened to cords to afford proper strain relief? Y / N Y / N Y / N Y / N Y / N
Multi-outlet power cords are rated for their use? Y / N Y / N Y / N Y / N Y / N
Are cords exposed to pinching hazards such as doors, windows or heavy
materials? Y / N Y / N Y / N Y / N Y / N
Are cords exposed to cutting hazards such as metal studs/track or sharp
unprotected edges? Y / N Y / N Y / N Y / N Y / N
Are cords exposed to water, moisture or chemicals rated for this use? Y / N Y / N Y / N Y / N Y / N
Are any cords smaller than 14 AWG being used? Y / N Y / N Y / N Y / N Y / N
Are cords exposed to heat, sparks or flame? Y / N Y / N Y / N Y / N Y / N
Are cords used for more than 90 days in one location, as a substitute for
permanent wiring? Y / N Y / N Y / N Y / N Y / N
Have cords been used in place of rope to tie down equipment or lift up
equipment such as buckets? Y / N Y / N Y / N Y / N Y / N
Are tools being hoisted or carried by their cords? Y / N Y / N Y / N Y / N Y / N
Site Specific Question: Y / N Y / N Y / N Y / N Y / N
Equipment and Tool Inspection
Is the equipment/tool grounded with a three prong cord? Y / N Y / N Y / N Y / N Y / N
If NOT: Is equipment/tool marked as double insulated? Y / N Y / N Y / N Y / N Y / N
Is cord frayed, damaged or pulled out from connector? Y / N Y / N Y / N Y / N Y / N
Is equipment/tool inspected on a regular schedule? Y / N Y / N Y / N Y / N Y / N
Have any problems been reported with this equipment/tool? Y / N Y / N Y / N Y / N Y / N
Site Specific Question: Y / N Y / N Y / N Y / N Y / N
Ground Fault Circuit Interrupter
Does pushing the "Test" button on GFCI trip the device? Y / N Y / N Y / N Y / N Y / N
Does pushing the "Reset" button on the GFCI rest the device? Y / N Y / N Y / N Y / N Y / N
Is the device chipped, cracked, or damaged? Y / N Y / N Y / N Y / N Y / N
Is the device labeled as GFCI protected? Y / N Y / N Y / N Y / N Y / N
Site Specific Question: Y / N Y / N Y / N Y / N Y / N
Please retain this form for one year for review by FM-Occupational Health and Safety
2/12/16 – WHR
