• Client / Site

  • Conducted on

  • Prepared by

  • Location


  • Signage or notification of required PPE

  • Fire Prevention

Fire Prevention

  • Extinguishers recently serviced? (Checked monthly and inspected yearly)

  • Extinguishers in place, clearly marked for type of fire as per NFPA 10 if obstructed from view.

  • Maximum travel distance to fire extinguisher less than 75 ft as per NFPA 5.2.3

  • Extinguishers clear of obstructions and at appropriate height(3 - 5 Feet) as per NFPA 10

  • Adequate notices for fire exits as perAlberta fire code

  • Exit doors easily opened from inside?

  • Any combustible material stored in furnace room? NFPA10.18.5.1 Combustible material shall not be stored in boiler rooms, mechanical rooms, or electrical equipment rooms.

  • Exits clear of obstructions?

  • Comments

  • Office inspection

Office inspection

  • Filing cabinets- secured? Locking mechanism working?

  • File cabinets properly loaded?

  • Chair condition- five star bases

  • Desk is clean and in good condition?

  • Extension cords

  • Lighting


  • Good natural lighting?

  • Reflected light from walls & ceilings not causing glare to employees?

  • Light covers clean, in good condition and properly in place?

  • Comments

  • Building Safety

Building Safety

  • Emergency exit lighting installed and operable as per National building Code

  • Floor surfaces even and uncluttered?

  • Entry and walkways kept clear?

  • Walkways adequately and clearly marked?

  • Intersections kept clear?

  • Stair and risers kept clear?

  • Loading area clean and tidy?

  • Hand rails and railing adequate?

  • Comments

  • Work benches

Work Benches

  • Clear of rubbish?

  • Tools not in use kept in place?

  • No damaged hand tools in use?

  • No damaged power tools or cords in use?

  • Work height correct for the type of work and the employee?

  • No sharp edges?

  • Are gas bottles secured?

  • Comments

  • Overhead Door
  • Inspection tag current

  • Door Panel condition

  • Rail condition

  • Glass condition

  • Electronic pad operational wire condition

  • Weather stripping

  • Storage design and use

Storage Design and Use

  • Materials stored in racks and bins wherever possible?

  • Storage designed to minimise lifting problems? Lift carts available?

  • Floors around racking clear of rubbish?

  • Storage racks secured to prevent tipping?

  • Outside storage marked if used for hazardous materials?

  • Outside storage areas have fire extinguisher with in 25 meters?

  • Comments

  • Equipment and machines

Equipment & Machines

  • Are they kept clean?

  • Lock out tag out available? Used?

  • Are the floors kept clean?

  • Guards in good condition?

  • Guards at acceptable distance?

  • Drip pans on floor to prevent spillage?

  • Adequate work space?

  • Is lighting adequate?

  • Noise levels controlled?

  • Comments

  • Energy use and efficiency

Energy use

  • Lights turned off when room not occupied?

  • Are automatic on / off controls installed or available?

  • Computer equipment and monitors turned off?

  • Programable thermostat used? Programmed correctly?

  • Weather stripping around doorways and windows? Condition of stripping?

  • Any leaking water fixtures?

  • Hot water tank setting appropriate?

  • Furnace condition, clean filter? On a preventative maintenance schedule?

  • Electrical


  • GFI outlets installed and tested?

  • Safety switch breaker tested?

  • No double adapters in use?

  • Area around panel kept clear of obstructions?

  • Electrical panel secure? No open breakers or boxes?

  • No broken plugs, sockets or switches?

  • No power leads across walkways?

  • No frayed or damaged leads?

  • Portable power tools in good condition?

  • Comments

  • Chemical Safety

Chemical Safety

  • Worker has up to date training?

  • Safety Data Sheets available for all chemicals?

  • All containers labelled correctly?

  • Unused substances disposed of?

  • Is PPE available?

  • Is adequate ventilation provided?

  • Are eye washes and showers easily accessed?

  • Comments

  • Ladders


  • Are all ladders Industrial strength? (Non Household rated, check label.)

  • Are ladders in good condition?

  • Comments

  • First Aid kit

First Aid Facilities

  • Eye wash station available, contents in acceptable condition and optimal placement?

  • Are cabinets and contents clean and orderly?

  • Are contents regularly checked?

  • Cabinets clearly labelled?

  • Is there easy access to cabinets?

  • Employees aware of location of first aid cabinet?

  • Are emergency numbers displayed?

  • Comments

  • Recyclables


  • Appropriate containers available?<br>

  • Secondary containment required?

  • Quantities do not pose a fire hazard?

  • Comments

  • Spill kit

Spill kit

  • Contents easily accessed?

  • Required contents available in spill kit

  • Contents in good condition or expired?

  • Yard site

Yard site

  • Fencing in proper condition?

  • External lighting operational ?

  • Material stored correctly?

  • Liquids and chemicals stored correctly? Secondary containment for barrel storage?

  • Travelled surface is level?

  • Yard site secure after hours

  • Comments

  • Building condition
  • Building siding in place

  • Roofing condition is acceptable?<br>Check from ground level

  • Eaves trough in place and in good condition?

  • Ceiling showing any signs of water damage?

Follow up items / corrective action

  • Follow up / corrective action

  • Add follow up / corrective action
  • Follow up / corrective action

  • undefined

  • Complete by:

  • Hazard Risk Rating
    A: Hazards have the potential for causing immediate and serious injury or damage
    B: Hazards are less severe, but still have potential for causing injury or damage
    C: Hazards/deficiencies that have potential to cause minor injury or damage

    1. Environmental
    2. Safety
    3. Procedures
    4. Equipment

  • Hazard risk rating

  • Assigned to:

Sign Off

  • On site representative

  • Auditor's signature

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.