Al Jazeera Hospital
Facility Management and Safety Department
Monthly Electrical Room Inspection
Date: _______________
Location
Panel
No.
Inspector: __________________________ Signature: ____________________
Rated
Voltage
(V)
Main
CB
Rating
(Amp)
Actual Reading
(Amp)
Actual
Voltage
(V)
L1
L2
L3
Thermograph Reading
(ºC)
N
L1
L2
L3
STATUS
Inspection Items
REMARKS
Satisfactory
1.
Internal and external parts are free of damage
2.
Panel is free from dust (internal and external)
3.
Ammeter and voltmeter are accurate
4.
Indicator lams are working, not busted.
5.
A/C temperatures are in range (22 º C- 27ºC)
6.
Cables are not frayed, not damaged and free from signs of
burning
Circuit breakers are free from damage and signs of burning,
overheating
7.
Unsatisfactory
Other Comments:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Prepared By:
Checked and Approved By:
Technician: _____________________
Engr. Ahmad Beshbishy – FMS Director: ___________________