Information

  • Organization Inspected

  • Conducted on

  • Inspection conducted by:

Findings

Finding 1

  • Date/Time

  • Building

  • Give description:

  • Room

  • Functional Area or Shop:

  • Supervisor or POC:

  • Phone Number:

  • Hazard or Deficiency:

  • Finding:

  • Reference:

  • Is this a hazard or deficiency?

  • RAC

  • Assign RAC:

  • Cause:

  • Recommendation:

  • 30 Day Follow-Up Date:

  • Corrective Action:

  • Supporting Picture:

  • Would you like to add another finding?

Finding 2

  • Hazard or Deficiency:

  • Finding:

  • Reference:

  • Is this a hazard or deficiency?

  • RAC

  • Assign RAC:

  • Cause:

  • Recommendation:

  • 30 Day Follow-Up Date:

  • Corrective Action:

  • Supporting Picture:

  • Would you like to add another finding?

Finding 3

  • Hazard or Deficiency:

  • Finding:

  • Reference:

  • Is this a hazard or deficiency?

  • RAC

  • Assign RAC:

  • Cause:

  • Recommendation:

  • 30 Day Follow-Up Date:

  • Corrective Action:

  • Supporting Picture:

  • Would you like to add another finding?

Finding 4

  • Hazard or Deficiency:

  • Finding:

  • Reference:

  • Is this a hazard or deficiency?

  • RAC

  • Assign RAC:

  • Cause:

  • Recommendation:

  • 30 Day Follow-Up Date:

  • Corrective Action:

  • Supporting Picture:

  • Would you like to add another finding?

Finding 5

  • Hazard or Deficiency:

  • Finding:

  • Reference:

  • Is this a hazard or deficiency?

  • RAC

  • Assign RAC:

  • Cause:

  • Recommendation:

  • 30 Day Follow-Up Date:

  • Corrective Action:

  • Supporting Picture:

  • Would you like to add another finding?

Finding 6

  • Hazard or Deficiency:

  • Finding:

  • Reference:

  • Is this a hazard or deficiency?

  • RAC

  • Assign RAC:

  • Cause:

  • Recommendation:

  • 30 Day Follow-Up Date:

  • Corrective Action:

  • Supporting Picture:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.