10-POINT HOME SAFETY CHECKLIST
CUSTOMER NAME
Date
-
Month
-
Day
Year
Date
BREAKERS
Single Poles / Tandem
Not UL Listed
Oversized / Other
Correct
2 Pole
Not UL Listed
Oversized / Other
Correct
Arc Fault
Protected
Unprotected
GFCI
Protected
Unprotected
Safe / Hazardous
Safe
Hazardous
Notes
Fixed / Corrected
-
Month
-
Day
Year
Date
PANEL
Brand
Age
Is it in a Closet
Yes
No
Amps
Aluminum Components
Yes
No
Is it a Hazardous Panel
FPE
Zinsco
Other
Split Bus Concerns?
Yes
No
Discoloration or Heat Damage?
Yes
No
Noticeable Weather Damage
Yes
No
Bonded Bushing Present?
Yes
No
Safe / Hazard
Safe
Hazard
Fixed / Corrected
-
Month
-
Day
Year
Date
Notes
GROUNDING SYSTEM
Ground Rod
QTY
Not Present
Size
Wire Size
Copper / Galvanized
Ground Rod Location
Cold Water Bond
Present / Not Present
Present
Not Present
Size
Bond Location
Inter System Bond
Present
Not Present
Safe / Hazardous
Safe
Hazardous
Fixed / Corrected
-
Month
-
Day
Year
Date
Notes
GFCI
Kitchen
Protected
Unprotected
Laundry
Protected
Unprotected
Bath
Protected
Unprotected
Garage
Protected
Unprotected
Pool / Outdoor
Protected
Unprotected
In Use Covers Present?
Yes
No
Temper Resistant / Waterproof?
Yes
No
Safe / Hazardous
Safe
Hazardous
Fixed / Corrected
-
Month
-
Day
Year
Date
Type a question
Smoke Detectors
Location
Existing
Yes
No
Needed
Yes
No
Hard Wired
Yes
No
Battery Only / Backup
Yes
No
Notes
Carbon Monoxide Detectors
Location
Existing
Yes
No
Needed
Yes
No
Hard Wired
Yes
No
Battery Only / Backup
Yes
No
Notes
Devices
Receptacles
Grounded
Non-Grounded
Tamper Resistant
3-Prong
2-Prong
Lightin
LED
Incandescent Bulbs
Pigtails?
Safe / Hazardous
Safe
Hazardous
Fixed / Corrected
-
Month
-
Day
Year
Date
Notes
Wiring Hazards / Hot Tub Equipment
Existing / Functioning
Yes
No
Ground / Bond Present
Yes
No
Safe / Hazardous
Safe
Hazardous
Fixed / Corrected
-
Month
-
Day
Year
Date
Notes
Electrical Service / Meter Base
Concerns
Detached
Heat Damage
Outdated
Overhead
Yes
No
Underground
Yes
No
Weather Damage
Yes
Amps
Safe / Hazardous
Safe
Hazardous
Fixed / Corrected
-
Month
-
Day
Year
Date
Notes
Attic & Crawl Space
Wiring Hazards
Yes
No
Safe / Hazardous
Safe
Hazardous
Fixed / Corrected
-
Month
-
Day
Year
Date
Notes
Signatures
Customer Signature
Technician Signature
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