• Audit Title

  • Facility/Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

1 - Marshall & Swift Valuation

Marshall & Swift Valuation

  • Year Built

  • Number of Employees:

  • Number of floors or stories:

  • Story height in feet:

  • Occupancy Type:

  • Building and Property Value:

  • Facility square footage:

  • Estimated Contents Value:

  • Passenger Elevators / How many?

  • Freight Elevators / How many?

  • Basement / Square Footage

  • Is Basement Finished?

  • Type and location of HVAC system:

  • Construction Type

  • Wall Construction

  • Roof Construction

  • Roof Support

  • Floor Construction

  • Automatic Fire Alarm System?

  • Sprinkler system?

  • Facility photos

2 - General



  • Does the employer furnish his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees?

  • Is the structure, furniture and equipment in the area, in good and safe condition?

  • Are floors clean and free of dirt and liquids?

  • Good lighting available?

  • Are restrooms facilities clean?



  • Best Management Practices:
  • Does the location follow Best Management Practices?


  • Employee OSHA (publication 3165) and U.S. Department of Labor Postings: 29 CFR 1903.2

  • OSHA publication 3165 & US Dept. of Labor Postings
  • Are the OSHA (publication 3165) and US Department of Labor Postings posted and available for the employees to read?

  • Risk Management Information

  • Risk Mgt. Contact and Medical Clinics Information
  • Are Charlotte-Mecklenburg Risk Management Contacts and Medical Clinics information posted?

3 - Housekeeping


  • Cleanliness and Sanitation

  • 29 CFR 1910(a)(1):
  • Are all places of employment kept clean and orderly and in sanitary condition?

  • Isles and passageways.

  • 29 CFR 1910.22(b)
  • Are all isles and passageways kept clear with no obstruction across the aisles that could create a hazard.

  • Other "OBSERVED" conditions.

  • Other observed Housekeeping hazards
  • Are all other "OBSERVED" conditions free from Housekeeping hazards?

4 - Electrical


  • Extension cords and power strips.

  • 29 CFR 1910.303 & 304
  • Are extension cords and electrical strips used in accordance with manufacturer's guidelines?

  • Are extension cords used only for immediate use and not as permanent wiring?

  • Are all extension cords free from damage and defects such as damage to the outer jackets (insulation) or missing grounding pins?

  • Are all electrical cords and electrical power strips free from daisy chaining and overloading?

  • Portable cord and plug equipment.

  • 29 CFR 1910.304
  • Are all portable cord and plug connected equipment and extension cords free from damage and defects such as damage to the outer jackets (insulation) or missing grounding pins?

  • Are all strain relief points free from exposed electrical wiries?

  • Electrical outlets, boxes, equipment casings, cabinets

  • 29 CFR 1910.305(b)
  • Are all unused openings in electrical outlets, boxes, equipment casings, cabinets closed to prevent exposure and accidental entry?

  • Do all boxes, junction boxes, fittings .....outlet fixtures have covers?

  • Is there exposed wiring?

  • GFCI

  • NFPA 70E 210.8 & 110.4
  • Are all electrical outlets installed within 1.8m (6 ft.) of the outside edge of a sink (laundry, utility, and wet bar sinks) GFCI protected?

  • Are all receptacles installed to serve the countertop surfaces in kitchens GFCI protected?

  • Is GFCI protection provided when an employee is outdoors and operating or using cord and plug connected equipment supplied by 125-volt, 15, 20 or 30 amp circuits?

  • Outdoor or other damp locations?

  • 29 CFR 1910.305 & 303
  • Are waterproof receptacles installed in outdoor locations or in other damp locations?

  • Are all electrical outlets and enclosures located in damp or wet locations free from visible damage?

  • Panel Labeling

  • 29 CFR 1910.303(e)(1)(ii) NFPA 70E:
  • Are labels providing voltage, current and protective clothing requirements posted on outside of electrical panels?

  • Are breakers properly labeled with circuit identification or area served?

  • Overhead lighting

  • 29 CFR 1910.305L(a)(2)(ix):
  • Are all lamps used for general illumination protected from accidental contact or breakage by a suitable fixture or guard?

  • Work on electrical equipment.

  • 29 CFR 1910.331-335
  • Do facility employees work on electrical circuits?

  • Is there a written Electrical Safe Work Practices policy?

  • Are employees who work with or on electrical circuits properly trained to the required level of their expected job function?

  • Are employees provided with the proper PPE and safeguards for working on electrical circuits.

  • Arcflash

  • NFPA 70E
  • Do employees work on live electrical circuits?

  • Is there an Arcflash and Live Electrical Work policy in place.

  • Are panels and other electrical equipment labeled with the current, voltage, and Arcflash information and required Arcflash PPE?

  • Are employees provided the proper Arcflash PPE for the hazards encountered?

  • Are employees properly trained in Arcflash safety and the proper use of Arcflash PPE?

  • Other "OBSERVED" Electrical hazards?

  • Other Observed Electrical Hazards
  • Are all other "OBSERVED"conditions free from Electrical hazards?

5 - Emergency Exits


  • Obstructions

  • 29 CFR 1910.37(3):
  • Are all exit routes free and unobstructed?

  • Exit Signage

  • 29 CFR 1910.37(b)..
  • Are all exits clearly visible and marked by a sign reading "Exit"?

  • Are all "Exit" signs illuminated?

  • Non-exit Doorways

  • 29 CFR 1910.37(b)(5):
  • Is each doorway which could be mistaken for and exit marked "Not an Exit"?

  • Emergency Exit Lighting

  • life Safety Code 101-67
  • Do all emergency lights operate for a minimum of 30 seconds when the test button is pressed?

  • Other "OBSERVED" Emergency Exit hazards?

  • Other observed Emergency Exit hazards
  • Are all other "OBSERVED" conditions free from Emergency Exit hazards?

6 - Eye Wash Stations


  • Are eye wash stations unblocked and placed within 10 seconds or 55 feet of the hazard?

  • ANSI Z358.1 2009: 29 CFR 1910.151:
  • Are eye wash stations unblocked and placed within 10 seconds or 55 feet of the hazard?

  • Are all eye wash stations flow tested on a weekly basis and mechanically tested annually?

  • Does the eye wash station deliver tepid (between 60 and 100 degrees F) water for 15 minutes?

  • Are the eyewash solutions for portable eye wash stations being inspected for expiration dates?

  • Other "OBSERVED" Eye Wash Station hazards?

  • Other Eyewash Station hazards
  • Are all other "OBSERVED" conditions free from Eye Wash Station hazards?

7 - Fire Alarm & Sprinkler


  • Fire Alarm System & Testing

  • NFPA-72, Table 10.4.3 Testing Frequencies
  • Is testing of the Fire Alarm System conducted in accordance with National Fire Protection Association (NFPA) testing schedule?

  • How often is the system tested/inspected?

  • Is the documentation available upon request?

  • Sprinkler System & Testing

  • Is testing of the Fire Alarm System conducted in accordance with National Fire Protection Association (NFPA) testing schedule?
  • Has the Fire Pump / Sprinkler System been inspected/tested?

  • How often is the system tested/inspected?

  • Is the documentation available upon request?

8 - Fire Extinguishers


  • Mounting and location.

  • 29 CFR 1910.157(c)
  • Are all portable fire extinguishers properly mounted, located and identified so they are readily accessible to employees?

  • Are all portable fire extinguishers kept in their designated places at all times except during use?

  • Inspections

  • 29 CFR 1910.157(e)
  • Do all of the fire extinguishers receive a monthly inspection?

  • Do all fire extinguishers receive an annual inspection?

  • Other "OBSERVED" Fire Extinguisher hazards?

  • Other observed Fire Extinguisher Safety Hazards
  • Are all other "OBSERVED" conditions free from Fire Extinguisher hazards?

9 - Fire / Life Safety


  • Emergency Action , Evacuation, Fire Prevention Plans

  • 29 CFR 1910.38 & 39
  • Are Emergency Action, Evacuation, and Fire Prevention Plans in place?

  • Do Emergency Action Plans address other hazards such as weather emergencies?

  • Are Emergency Evacuation Diagrams or directions posted?

  • Are Emergency Plans communicated to employees and are employees trained on the actions to take during an emergency.

  • Are periodic Emergency and Evacuations Drills Conducted?

  • Combustible Materials

  • Fire Code 2009 Chapter 3:315.2
  • Are combustible materials in buildings separated from heaters or heating devices by distance or shielding so ignition cannot occur?

  • Are combustible materials kept to a minimum and not allowed to accumulate ?

  • Flammable and Combustable Storage

  • 29 CFR 1910.106(d)(3)(ii)
  • Are all flammables and combustibles properly stored in flammable cabinets?

  • Are "ONLY" flammables and combustibles stored in flammable cabinets?

  • Ceiling Clearance.

  • International Fire Code 2009:315.2.1
  • Is storage maintained 18" from sprinkler heads in buildings which have fire sprinkler systems?

  • Is storage maintained 24 inches below the ceiling in non-sprinkled buildings?

  • Fire Resistance Rated Components

  • International Fire Code 2009 703.1
  • Is the required fire-resistance rating of fire resistance-rated construction (including ceiling tiles) maintained and properly repaired, restored or replaced for any openings including openings made for passage of pipes, electrical conduit, wires, ducts, air transfer openings and any holes made for any other reason?

  • Other "OBSERVED" Fire Safety hazards?

  • Other Observed Fire Safety HazardsAre
  • Are all other "OBSERVED" conditions free from Fire Safety hazards?

10 - Hazard Communication


  • MSDS / SDS

  • 29 CFR 1910.1200
  • Is there a list of hazardous chemicals known to be present and are the appropriate safety data sheet available to employees?

  • Are employees properly trained on the chemical hazards. In the workplace and the facilities Hazard Communication Plan?

  • Are all chemical containers labeled properly?

  • Other "OBSERVED" Hazard Communication hazards?

  • Other Hazard Communication hazards
  • Are all other "OBSERVED" conditions free from Hazard Communication hazards?

11 - Machinery / Machine Guarding


  • Machine Guarding

  • 29 CFR 1910.212(a)(1) :
  • Do all tools and machines have the proper machine guarding to protect the operator from hazards at the point of operation? <br>

  • Grinders

  • 29 CFR 1910.215
  • Are all GRINDER work rests adjusted closely to the wheel with a maximum opening of one eighth (1/8) of an inch?

  • Are all GRINDER safety guards adjusted so as to never exceed one-fourth (1/4) of an inch between the wheel to the guard?

  • Machine Mounting

  • 29 CFR 1910.305(b)(2)(i)
  • Are all machines designed for a fixed location securely anchored to prevent walking or moving?

  • Other "OBSERVED" Machine Guarding hazards?

  • Other Machine Guarding hazards
  • Are all other "OBSERVED" conditions free from Machine Guarding hazards?

12 - Powered Industrial Trucks / Scissor Lifts


  • Forklifts

  • 29 CFR 1910.178
  • Are forklifts or powered industrial trucks used in the facilit?

  • Have employees operating forklifts or powered industrial trucks been properly trained and certified?

  • Are ther policies and procedures in place for the proper operation of the equipment?

  • Is the forklift or powered industrial truck properly maintained and the correct type for the intended use?

  • Scissor Lifts

  • ANSI & 29 CFR 1910.29
  • Are scissor lifts used in the facility?

  • Are employees properly trained in the use of the scissor lift?

  • Are all guard and side rails in place and no work is performed with the side rails removed?

  • Is the scissor lift properly maintained and inspected?

  • Other "OBSERVED" Powered Industrial Truck hazards?

  • Other PPE hazards
  • Other "OBSERVED" Powered Industrial Truck hazards?

13 - Personal Protective Equipment


  • Personal Protective Equipment

  • 29 CFR 1910.132
  • Has a JSA (Job Safety Analysis) been performed to determine the correct PPE for the task?

  • Is required PPE provided to the employees and do the employees wear the required PPE?

  • Is the PPE maintained and stored in a sanitary and reliable condition to prevent damage and/or contamination?

  • Other "OBSERVED" PPE hazards?

  • Other PPE hazards
  • Are all other "OBSERVED" conditions free from PPE hazards?

14 - Walking Working Surfaces


  • Ladders

  • 29 CFR 1910.25
  • Do the ladders have the ladder manufacturer's information and warning labels in place and are they legible?

  • Are all ladders inspected prior to use and taken out of service if any defects are found?

  • Is the ladder observed in use the correct type of ladder for the job being performed?

  • Are the observed ladders which are not in use stored properly and secured?

  • Aisles, passageways, and floors.

  • 29 CFR 1910.22
  • Are all aisles, passageways, and floors clean and free of hazards?

  • Are covers and or guardrails provided to protect employees from floor openings, pits, or other open floor hazards?

  • Are placards indicating the applicable load rating of the floor provided?

  • Are there any areas where the floor safe load rating has been exceeded?

  • Other observed walking working surface safety hazards?

  • 29 CFR 1910.25
  • Are all other observed conditions free from any other walking working surface safety hazards?

15 - Welding, Cutting, Brazing


  • Welding Operations

  • 29 CFR 1910.252
  • Is the employee properly trained for the task?

  • Is adequate ventilation provided?

  • Is the proper PPE provide to and used by the employee?

  • Hot Work Permit

  • 29 CFR 1910.252
  • Does the facility have a Hot Work Permit program?

  • Are contractors required to follow a Hot Work Permit program?

  • Compressed gas cylinders.

  • 29 CFR 1910.253 & 1910.101
  • Are all compressed gas cylinders legibly marked for the purpose of identifying the gas content?

  • Are oxygen cylinders in storage separated from fuel-gas cylinders or combustible materials by a minimum of 20 feet or by a noncombustible barrier at least 5 feet high?

  • Are cylinders stored with protective caps in place over valve stems?

  • Are cylinders stored and anchored in such a way to prevent falling?

  • Other "OBSERVED" Welding, Cutting and Brazing hazards?

  • Other Welding, Cutting and Brazing hazards
  • Are all other "OBSERVED" conditions free from Welding, Cutting and Brazing hazards?

16 - Other Hazards / Conditions

Other Observed Conditions

  • Other "Observed" potential hazards to the employees?

  • Do all other conditions at the location provide a safe workplace free from potential hazards to employees?

Auditor's Comments:



  • Department / Facility representative:

  • Participating Risk Management Representative:

Auditor's Comments

Auditor's Comments:

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.