Title Page
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Building/Facility Name
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Room number, adjacent to. etc
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Inspector's Name
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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
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Are there electrical equipment hazards that are likely to cause death or serious physical harm?
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Are there open holes in boxes, cabinets or fittings or are conductors entering not protected from abrasion?
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Are outlets in all wet or potentially wet areas not protected with a ground-fault circuit-interrupter (GFCI)?
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Is there less than 36 inches of clearance in front of all electrical panels?
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Are pull boxes, junction boxes, and fittings open or lacking approved covers?
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Do grounded outlets or power strips have an installed load that is not appropriately sized for the power supply?
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Are electrical components and equipment broken, damaged, bent, cut, deteriorated by corrosion, chemical action or overheating?
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Are live parts of electric equipment operating at 50 volts or more unguarded against accidental contact?
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Are power strips “daisy chained” (plugged in a series) rather than being plugged directly into the outlet?
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Are extension cords or other temporary wiring being used as permanent wiring?
Emergency
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Are there non-functional emergency lights, alarms or annunciators?
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Are there areas with corrosive or hazardous material use without an eye wash and/or safety shower that is available and maintained?
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Are there expired or missing first aid supplies (where medical services are not present) or an automated external defibrillator (AED) that is not ready to be used (unexpired, inspected)?
Environmental
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Are used oil drums being stored outside of secondary spill containment?
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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?
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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?
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Is there silt fence that is not installed properly or maintained in good condition?
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Are perimeter soil erosion/sediment controls not in place, maintained or effective?
Fire - Egress
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Are there obstructions in aisles, stairs or hallways that could block exits?
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Is there storage in stairwells?
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Are required/installed exit signs not working, damaged, or blocked/covered (i.e. not visible)?
Fire - Prevention
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Does a mechanical, electrical, or boiler room contain storage of combustible material?
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Fire rated and labeled doors have been field modified, are being blocked open, or are not working properly or positively latching?
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Are there penetrations of a required fire barrier missing fire-stopping, or require fire-stopping correction(s)?
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Is a portable, electrical space heater plugged into an extension cord, not equipped with a tip over switch, or not kept 3 feet away from any combustible material?
Fire – Protection
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Are portable fire extinguishers obstructed, missing, improperly positioned, not charged, or lacking monthly or annual inspection tags?
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Is there storage closer than 2 feet below the ceiling in areas without fire sprinklers, or closer than 18 inches below sprinkler heads?
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Is more than 20% of room’s ceiling missing or are there any openings greater than 4ft long?
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Are there missing ceiling tiles or openings where a sprinkler head is installed?
General Safety
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Are lockout and tagout devices being used not only for controlling hazardous energy while work is being done, but also for other purposes (taking equipment out of service or for operational reasons)?
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Is the area not clean, orderly or in a sanitary condition?
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Are there physical hazards not 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”?
Remarks/Recommendations
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