Title Page

  • Building/Facility Name

  • Room number, adjacent to. etc

  • Inspector's Name

  • Inspection Date

Instructions: Complete this inspection and enter any findings that need to be addressed in WebTMA. If you fixed an item during the inspection, please note that you took corrective action. "Yes" items that cannot be corrected in the field require a WO request.

Electrical

  • Is electrical equipment free from hazards, such as breakage, damage, frayed/damaged wiring, corrosion, chemical exposure or excessive heat, missing ground plugs?

  • Are electrical boxes and cabinets free from open holes and other openings?

  • Is electrical wiring entering electrical cabinets protected from abrasion?

  • Do receptacles and switches have faceplate covers affixed?

  • Are receptacles (faceplates) and switch plates affixed with a cover?

  • Are outlets in wet or potentially wet areas equipped with a ground-fault-circuit-interrupter (GFCI) (e.g., within 6 ft of a sink)?

  • Is there at least 36 inches of clearance in front of all electrical panels?

  • Do outlets or power strips have labels that indicate the maximum electrical load they can handle safely?

  • Are power strips plugged directly into outlets, rather than "daisy chained" (plugged in a series)?

  • Are extension cords or other temporary wiring being used as permanent wiring?

  • Are extension cords or other temporary wiring not being used as permanent wiring (not in place more than 90 days)?

  • Are electrical cords that run across walkways covered by runners?

Emergency

  • Are all emergency lights, alarms or annunciators functional?

  • Are eye wash stations and/or safety showers available, maintained and inspected in areas where corrosive or hazardous materials are used?

  • Are first aid kits in their designated location and fully supplied?

  • Are first aid supplies up to date (no expired items)?

  • Is the light on the automated external defibrillators (AEDs) flashing green?

Environmental

  • Are used oil drums being stored outside of secondary spill containment?

  • Are universal wastes (e.g., spent fluorescent lamps or batteries) being stored in open containers, not labeled with the words “Universal Waste Lamps” or “Universal Waste Batteries”, and/or on-site for over a year?

  • Are hazardous wastes (e.g. lead, spent solvents, etc.) being stored in open containers, not labeled with the words “Hazardous Waste” along with the container contents and hazards, and/or on-site for over 90 days?

  • Is there silt fence that is not installed properly or maintained in good condition?

  • Are perimeter soil erosion/sediment controls not in place, maintained or effective?

Fire - Egress

  • Are aisles, stairs and hallways unobstructed and exits clear from furnishings, furniture, etc.?

  • Are the stairwells free from storage and other obstructions?

  • Are required/installed exit signs working, visible (i.e. unblocked/uncovered) and in good repair?

Fire - Prevention

  • Are mechanical, electrical, and boiler room(s) free from combustible material storage?

  • Are fire rated and labeled doors unaltered, clear, working properly, self-closing, and positively latching?

  • Do the penetrations of a required fire barrier have fire-stopping in place and in good repair?

  • Are portable, electrical space heaters plugged directly into a wall (no extension cord), equipped with a tip over switch, and kept 3 feet away from any combustible material?

Fire – Protection

  • Are portable fire extinguishers in place, unobstructed, properly positioned, charged, and equipped with monthly and annual inspection tags?

  • Is there storage clearance at least 2 feet below the ceiling in areas without fire sprinklers, and at least 18 inches below sprinkler heads?

  • Is more than 20% of room’s ceiling missing or are there any openings greater than 4ft long?

  • Are ceiling tiles in place and intact especially near sprinkler heads?

General Safety

  • Are lockout and tagout devices being used to prevent accident discharge from energy sources while work is being done, or other purposes (e.g., equipment out of service)?

  • Are hazardous areas such as moving or rotating parts of machines/equipment protected by guards or covers?

  • Are walkways clean, free of trip and slip hazards (i.e., spills, loose/damage carpet, protruding objects, electrical cords, etc.)?

  • Are physical hazards marked in yellow or, if appropriate, signed or padded to warn against conditions which might result in striking against, falling, tripping or being “caught in between”?

  • Are Safety Data Sheets (SDS) available for chemicals used in the work area?

  • Are containers of hazardous chemicals labeled with the name of the chemical and hazard warnings (e.g. corrosive, flammable, etc.)?

  • Are file cabinet drawers closed when not in use?

  • Are heavier items stored in the bottom file cabinet drawers to prevent the cabinet from tipping over?

  • Are materials/items securely stacked when stored (e.g., stacked items are limited in height and secured against sliding or collapse)?

  • Are any available step stools or ladders free from damage?

  • Is the "Your Rights in the Congressional Workplace" OCWR's poster placed in a conspicuous location?

Remarks/Recommendations

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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.