Pollution Prevention Equipment Inspection Form
Facility Name
Location
Inspector
Date
Equipment Inspected
Equipment
Condition
Maintenance Needed
Comments
Good
Needs Repair
Not Working
Yes
No
Good
Needs Repair
Not Working
Yes
No
Good
Needs Repair
Not Working
Yes
No
Observations
Corrective Actions Taken / To Be Taken
Next Inspection Date
Inspector Signature