Dairy Farm Milking Machine Inspection Form

Date of Inspection Inspector Name Farm Name / Location Milking Machine Model Serial Number Inspection Items

Component	Status	Comments
Vacuum Pump	OK Repair Needed
Pulsator	OK Repair Needed
Milk Claws	OK Repair Needed
Rubber Liners	OK Replacement Needed
Milk Hose	OK Repair Needed
Vacuum Gauge	OK Repair Needed
Other	OK Repair Needed

General Comments Inspector Signature