Extension Cord Inspection Form
Document Control Company: [COMPANY NAME] · Logo: [COMPANY LOGO] · Address: [COMPANY ADDRESS] Prepared by: [RESPONSIBLE PERSON] · Date: [DATE] · Approved by (signature): _________________
| Field | Value |
|---|---|
| Category | Electrical Safety |
| Recommended Industry | All |
| Document Type | Form |
| Access Level | Starter |
| Last Reviewed | 2026-06-29 |
| Last Updated | 2026-06-29 |
How to Use This Template
Complete the fields as fully and accurately as possible at the time of the task or event. Route the completed document per your internal process and retain it with your records.
Template Body
Inspect cords before use; remove damaged cords from service.
| Cord ID | Inspected For | Pass | Fail |
|---|---|---|---|
| [____] | Insulation — no cuts, cracks, exposed wires | ☐ | ☐ |
| [____] | Ground pin present and intact | ☐ | ☐ |
| [____] | Plug/connector not damaged or overheated | ☐ | ☐ |
| [____] | Rated for the load and jobsite/outdoor use | ☐ | ☐ |
| [____] | No splices or makeshift repairs | ☐ | ☐ |
| [____] | GFCI protection in use | ☐ | ☐ |