Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
General Office Area
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Lobby (5S, Lighting, Visitor Log correctly filled out, furniture, etc)
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Hazard Class
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General Office 5S (Floors, Supplies Cube, Copier Cube)
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Hazard Class
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Kitchen (5S)
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Hazard Class
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Restrooms (5S)
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Hazard Class
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Lighting
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Hazard Class
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Comments
Small Conference Room
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5S
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Hazard Class
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Lighting
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Hazard Class
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Comments
Large Conference Room
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5S
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Hazard Class
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Lighting
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Hazard Class
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Comments
Stairs/Engineering Conference Room
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5S (Stairs, Floors, Material, etc)
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Hazard Class
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Lighting
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Hazard Class
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Comments
Training Room
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5S (Material, Tables, Chairs, Back Counter, etc)
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Hazard Class
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Lighting
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Hazard Class
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Training Room Restrooms (5S, Supplies, etc)
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Hazard Class
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Comments
First Aid Cabinet
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AED System Check (Green button)
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Hazard Class
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AED Battery Expiration Date (Remove battery cover)
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Hazard Class
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AED Supply Contents (List in cabinet. Supplies in AED case.
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Hazard Class
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Latex Gloves (1)
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Triangular Badge (1)
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Antihistamine Tablets (10)
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Tweezers/Splinter Out (1)
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Scissors (1)
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Resuscitation Barrier (1)
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Gauze Roll - 3" (2)
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Ice Pack (2)
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Flex Wrap Roll (2)
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Hydrocortisone Cream (10)
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Antacid (25)
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Band Aid (50)
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Antiseptic Wipes (20)
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Burn Treatment (1)
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Adhesive Tape (1)
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Eye Wash (1)
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Eye Covering (1)
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Triple Antibiotic Ointment (10)
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Gauze pads 4"x4" (10)
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Gauze Pads 3"x3" (10)
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Tylenol (50)
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Advil/Ibuprofen (50)
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Comments
Janitor's Closet
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5S
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Hazard Class
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Lighting
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Hazard Class
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Safety Data Sheets (Posted in binder on wall)
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Hazard Class
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Comments
Office Parking Lot
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Exterior Stairs
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Hazard Class
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Parking Lot/Walking Surfaces (Clear. Free from oil, ice, etc)
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Hazard Class
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Storm Drains (Clear, Free from oil)
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Hazard Class
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Propane Storage Cages Locked
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Hazard Class
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Shipping/Receiving Surface
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Hazard Class
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Transformers (Locked & No Fluid)
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Hazard Class
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Comments
