TITLE:	ES&H Manual
DOCUMENT ID:	6200 Appendix T2 Electrical Equipment Safety Inspection Checklist

Instruction for filling out this form can be found in ES&H Manual Chapter 6200 Appendix T1 Electrical Safety Inspection Procedure.

Jefferson Lab Electrical Equipment Checklist
Equipment Name:				Manufacturer:
Equipment Owner:				Model Number:
Division:				Serial Number:
Equipment Location: Required for fixed equipment only				JLAB Property #:
Unlisted electrical equipment that is determined to be safe to operate will have a tracking sticker attached for identification.
Standards or Codes used to evaluate equipment:
Enclosure					Approve	N/A
Operator not exposed to any hazard
Not damaged
Appropriate material used
Protects contents from operating environment
Adequate shock protection (components well secured)
Will contain any arcs, sparks and electrical explosions
Power Source - cord and plug					Approve	N/A
Proper voltage and ampacity for plug and cord
Grounding conductor included
Not frayed or damaged
Proper wiring of plug
Strain relief on cord
Power Source - direct wired					Approve	N/A
Proper voltage and ampacity rating for wiring method
Installation according to the NEC
Proper loading and overcurrent protection in branch circuit
Foreign power supplies and equipment					Approve	N/A
Connected to facility power with appropriate adapters
Correct voltage, frequency and phasing
Correct wire ampacity for United States use
Grounding					Approve	N/A
Ground is properly connected
All non-current carrying exposed metal is properly bonded
All non-current carrying internal subsystems are properly bonded
Equipment ground is run with circuit conductors
Auxiliary ground is permitted
Internal wiring					Approve	N/A
Polarity correct
Phasing correct
Landing of ground correct
Separate line / high voltage from low voltage
Wiring terminals and leads ok (no tension on terminals)
Proper wire size
No loose parts (mechanical bracing)
Proper overcurrent protection
Proper dielectric
Marking requirements					Approve	N/A
Power requirements (voltage, current, frequency)
Restrictions and limitations of use
Make, model and serial number
Hazards, including stored energy
Requirements for access (LTT, stored energy, PPE)
Test performed					Approve	N/A
Ground continuity
Leakage current to ground
Dielectric withstand: Primary circuit to ground
Polarization of cord and plug
Functional tests (GFCI, Emergency shutoff)
Automatic discharge of high voltage capacitor
Other issues					Approve	N/A
Neat workmanship
proper management of conductors
Free from sharp edges
Proper cooling (review equipment owner’s tests or analysis)
Switches and controls readily accessible
Any safety issues with access and maintenance
Failure analysis					Approve	N/A
Effect of ground fault
Effect of short circuit
Effect of interlock failure
Effect of overload
Effect of incorrect setting
Secondary hazards					Approve	N/A
RF hazards
DC electric or magnetic fields
IR, visible or UV
X-Rays
Fire or electrical explosion
Documentation					Approve	N/A
Documentation adequate
Operating procedures
Training and qualifications requirements
Equipment Inspection Summary: If not approving equipment for use, then include any corrective actions that need to be satisfied before scheduling a re-inspection.
Approved with Variance: Enter a description for variance requirements.
Inspection Date:		Inspector Name: Inspector Signature:
*** To Be Completed by the Electrical Safety Engineer***
	This equipment is approved for use at Jefferson Lab
			Inspection Tag number
	This equipment is rejected for use at Jefferson Lab
IF THIS EQUIPMENT IS MODIFIED, DAMAGED OR UTILIZED FOR OTHER THAN THE INTENDED USE, THIS APPROVAL IS VOID, PENDING RE-EXAMINATION.