BSD Inspection Template

• Room Number:

• Inspected by:

• Conducted on

  Date

Slip, Trip and Fall

• Walking surfaces are free of obstructions?<br>Walking surfaces to & from Exit are free of obstructions? <br>

  Yes

  No

  N/A

• Floors are clean, dry & in good condition?<br>

  Yes

  No

  N/A

• There are no floor holes greater than 1"?<br>

  Yes

  No

  N/A

• All floor holes, open pits, vats & ditches are guarded with a guardrail and/or have a toe board or floor cover?<br>

  Yes

  No

  N/A

• Wall openings with a drop of more than 4 ft. are guarded with a guardrail and/or have a toe board where necessary?<br>

  Yes

  No

  N/A

• Storage areas are free from accumulation of materials that may cause tripping, fire or explosion hazards?<br>

  Yes

  No

  N/A

• There is no overhead storage of materials on top of cabinets, equipment or piping?<br>

  Yes

  No

  N/A

• Storage in tiers is stacked, blocked & interlocked & limited in height for stable & secure storage?<br>

  Yes

  No

  N/A

• ADDITIONAL COMMENTS:

Exits

• All exit doors are in good working order?<br>

  Yes

  No

  N/A

• Any door or passage that is NOT an exit and is likely to be mistaken as an exit is marked "NOT AN EXIT"?<br>

  Yes

  No

  N/A

• All emergency exits are labeled, (above the door), with readily visible signage?<br>

  Yes

  No

  N/A

• If the sign is lighted, is it functioning properly?<br>

  Yes

  No

  N/A

• ADDITIONAL COMMENTS:

Emergency Equipment

• Fire extinguishers are inspected monthly? (Check date on tag)<br>

  Yes

  No

  N/A

• Fire extinguishers are hung on a wall or located in appropriately labeled cabinets?<br>

  Yes

  No

  N/A

• Safety equipment (fire extinguishers, eyewash, shower pull stations) are not blocked?<br>

  Yes

  No

  N/A

• ADDITIONAL COMMENTS:

PPE

• Current PPE hazard assessments posted in the area & available for use?<br>

  Yes

  No

  N/A

• ADDITIONAL COMMENTS:

Electrical/Energy Control

• Electrical equipment is marked with the manufactures name & applicable rating?<br>

  Yes

  No

  N/A

• Each disconnect is marked to indicate its purpose?<br>

  Yes

  No

  N/A

• Adequate working clearance, (3 ft. in front X 30" wide), & illumination are provided for all working spaces around electrical equipment?<br>

  Yes

  No

  N/A

• Pull boxes, junction boxes & fittings are appropriately covered?<br>

  Yes

  No

  N/A

• Light fixtures less than 7 ft. high do not have exposed parts?<br>

  Yes

  No

  N/A

• Conduits containing live wires have covers, knockout plates, elbows, etc. in place?<br>

  Yes

  No

  N/A

• Electrical circuit breakers are clearly labeled to their use? (inside of door - legible).<br>

  Yes

  No

  N/A

• All unused circuits are covered with a blank & marked "SPARE"?<br>

  Yes

  No

  N/A

• Electrical cords are not secured with electrical cable ties?<br>

  Yes

  No

  N/A

• Extension cords are not being used?<br>

  Yes

  No

  N/A

• ADDITIONAL COMMENTS:

Additional Safety & Housekeeping

• Are ladders well maintained? - <br><br>

  Yes

  No

  N/A

• Are ladders in their designated location?

  Yes

  No

  N/A

• LADDER INSPECTION & SIGN OUT SHEETS-<br>Please remove and return used sheet(s) to the Safety Coordinator & replace with a NEW sheet(s).

  Yes

  No

  N/A

• Palletized materials are stored securely in racks? (Pallets in good condition).<br>

  Yes

  No

  N/A

• ADDITIONAL COMMENTS:

Chemical / Gas Cylinder Storage

• All single, in use, gas cylinders are secured & upright?<br>(No nesting of in-use cylinders.)<br>

  Yes

  No

  N/A

• All non-vented flammable liquid cabinets have the bung in place?<br>

  Yes

  No

  N/A

• MSDS books are current & available?<br>

  Yes

  No

  N/A

• All chemicals are labeled with proper HMIS labels?<br>

  Yes

  No

  N/A

• All pipes are labeled as to contents & direction of flow of materials?<br>

  Yes

  No

  N/A

• Toxic, Flammable, Oxidizing & Corrosive gasses are stored in approved cabinets?<br>

  Yes

  No

  N/A

• Storage areas are well ventilated, dry & made of fire resistant construction?<br>

  Yes

  No

  N/A

• Containers are protected from bottom corrosion?<br>

  Yes

  No

  N/A

• Emergency showers & eyewashes are present where acidic or caustic gases are used?<br>

  Yes

  No

  N/A

• No more than 25 gallons of flammable liquids are stored outside of an approved storage cabinet?<br>

  Yes

  No

  N/A

• ADDITIONAL COMMENTS:

FOLLOW UP ITEMS - ADDITIONAL NOTES:

• ADDITIONAL COMMENTS: