High Voltage Insulating Gloves Inspection
Site
Name
First Name
Last Name
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Class
Manufacturer
Color
Left Insulating Glove Serial Number
Left Insulating Glove Recertification Date (6-months from last test if testing date is marked
Visual Inspection
Acceptable
Marginal
Unacceptable
Inflation Test
Acceptable
Marginal
Unacceptable
Right Insulating Glove Serial Number
Right Insulating Glove Recertification Date (6-months from last test if testing date is marked
Visual Inspection
Acceptable
Marginal
Unacceptable
Inflation Test
Acceptable
Marginal
Unacceptable
Left Glove Protector Visual Inspection
Acceptable
Marginal
Unacceptable
Right Glove Protector Visual Inspection
Acceptable
Marginal
Unacceptable
Glove Bag Visual Inspection
Acceptable
Marginal
Unacceptable
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