CHQ Monthly Inspection v1.0

• Select the month for which this audit is being completed.

  Select Janaury February March April May June July August September October November December

  • Janaury
  • February
  • March
  • April
  • May
  • June
  • July
  • August
  • September
  • October
  • November
  • December

• Date of Audit

  Date

• Name of auditor

• Is the board posted in a visible area to all employees?

  Yes

  No

  N/A

• Is the current Company Health and Safety Policy posted ? (signed by Chris Taylor)

  Yes

  No

  N/A

• Are all the names posted for the JHSC accurate?

  Yes

  No

  N/A

• Are the monthly safety inspections posted ? (Last 3 months should be available)

  Yes

  No

  N/A

• Is the Occupational Health and Safety Act of British Columbia readily accessible?

  Yes

  No

  N/A

• Are the JHSC meeting minutes posted? (Last 3 months should be available)

  Yes

  No

  N/A

• Is the map to nearest hospital posted?

  Yes

  No

  N/A

• Is the emergency evacuation map posted?

  Yes

  No

  N/A

• Additional Information

• Add media

  Media

• Date of Audit

  Date

• Name of auditor

• Are all rolling ladders in good working condition?

  Yes

  No

  N/A

• Are all A-frame ladders in good working condition?

  Yes

  No

  N/A

• Are all A-frame ladders secured to the wall?

  Yes

  No

  N/A

• Are all dollies in good working condition?

  Yes

  No

  N/A

• Are all manual pallet jacks (pump trucks) in good working condition?

  Yes

  No

  N/A

• Additional Information

• Add media

  Media

• Date of Audit

  Date

• Name of auditor

• Are all the rooms neat and organized? (Clean floor and all supplies neatly organized)

  Yes

  No

  N/A

• Are all the Safety Data Sheets for the chemicals present readily available?

  Yes

  No

  N/A

• Are all the Safety Data Sheets current (must not be older than 3 years)?

  Yes

  No

  N/A

• Is basic PPE readily available (gloves and face masks)?

  Yes

  No

  N/A

• Is an Eye Wash bottle / station readily accessible? (If an eye wash bottle is present check to make sure it is not expired)

  Yes

  No

  N/A

• Additional Notes

• Add media

  Media

• Date of Audit

  Date

• Name of auditor

• Is the First Aid Room readily accessible ? (Not locked and no obstruction in front of the door)

  Yes

  No

  N/A

• Are all overhead lights working?

  Yes

  No

  N/A

• Is the First Aid room neat, clean and tidy?

  Yes

  No

  N/A

• Are all the names of First Aid attendants clearly listed?

  Yes

  No

  N/A

• Are the oxygen tanks minimum half full ? (Check the gauge)

  Yes

  No

  N/A

• Has the Monthly First Aid Room Checklist for the prior month completed ?

  Yes

  No

  N/A

• No random chemicals (non-household) are present?

  Yes

  No

  N/A

• Additional Information

• Add media

  Media

• Are the evacuscape chairs are mounted with no visible signs of tampering or damage?

  Yes

  No

  N/A

• Are AED units present in their respective holders?

  Yes

  No

  N/A

• Do the AED's have non-expired parts? (Open AED case to inspect)

  Yes

  No

  N/A

• Additional Information

• Add media

  Media

• Date of Audit

  Date

• Name of Auditor

• Are all ceiling tiles intact, undamaged and in place?

  Yes

  No

  N/A

• Is overhead lighting functional with no burnt-out lights?

  Yes

  No

  N/A

• Are all seating areas in good shape with no broken chairs or tables?

  Yes

  No

  N/A

• Have all fire extinguishers been inspected?

  Yes

  No

  N/A

• No random chemicals (non-household) are present?

  Yes

  No

  N/A

• Additional Notes

• Add media

  Media

• Date of Audit

  Date

• Name of auditor

• Are all the emergency doors free of obstruction on the outside of the building?

  Yes

  No

  N/A

• Are all exterior building lights functional? (If conducting the inspection in the daytime, connect with maintenance dept)

  Yes

  No

  N/A

• Are all walkways free of obstruction and trip hazards?

  Yes

  No

  N/A

• Are all stairways free of damage with guard rails in good condition?

  Yes

  No

  N/A

• Additional Information

• Add media

  Media

• Date of Audit

  Date

• Name of Auditor

• Are all the aisle ways in the room , free and clear of obstruction?

  Yes

  No

  N/A

• Have all fire extinguishers been inspected in the last 12 months?

  Yes

  No

  N/A

• Is all overhead lighting functional ?

  Yes

  No

  N/A

• No random chemicals (non-household) are present?

  Yes

  No

  N/A

• Date of Audit

  Date

• Name of Auditor

• Are all ceiling tiles intact, undamaged and in place?

  Yes

  No

  N/A

• Is overhead lighting functional with no burnt-out lights?

  Yes

  No

  N/A

• Are all seating areas in good shape with no broken chairs or tables?

  Yes

  No

  N/A

• Have all fire extinguishers been inspected?

  Yes

  No

  N/A

• Are all dollies and pump trucks in good working order?

  Yes

  No

  N/A

• Is there good housekeeping with tripping / falling hazards?

  Yes

  No

  N/A

• No random chemicals (non-household) are present?

  Yes

  No

  N/A

• Additional Notes

• Add media

  Media

• Date of Audit

  Date

• Name of Auditor

• Are the rooms clean and organized?

  Yes

  No

  N/A

• Is all overhead lighting functional?

  Yes

  No

  N/A

• No random chemicals (non-household) are present?

  Yes

  No

  N/A

• Additional Information

• Add media

  Media

• Date of Audit

  Date

• Name of Auditor

• Is there adequate lighting in the room?

  Yes

  No

  N/A

• Is the room free and clear of clutter?

  Yes

  No

  N/A

• Is the floor clean with no spills?

  Yes

  No

  N/A

• No random chemicals (non-household) are present?

  Yes

  No

  N/A

• Additional Information

• Add media

  Media

• Are all walking surfaces free of damaged flooring / cracked tiles / lifting carpet?

  Yes

  No

  N/A

• There is no clutter / obstructions / tripping and slipping hazards?

  Yes

  No

  N/A

• Have all fire extinguishers been inspected ? (Check tag to see if an inspection has been done in the past 12 months)

  Yes

  No

  N/A

• Are all ceiling tiles intact, undamaged and in place?

  Yes

  No

  N/A

• Are all overheard emergency exit signs undamaged and lit?

  Yes

  No

  N/A

• Is Emergency lighting in place and regularly tested for operational readiness? (Check with maintenance for operational readiness information)

  Yes

  No

  N/A

• Are all overhead sprinkler heads free and clear of obstruction (minimum 18 inches clearance)?

  Yes

  No

  N/A

• Is overhead lighting functional with no burnt-out lights? (Check main passageways only)

  Yes

  No

  N/A

• Are all emergency doors free and clear of obstruction?

  Yes

  No

  N/A

• Are all glass panels free of damage?

  Yes

  No

  N/A

• No random chemicals (non-household) are present?

  Yes

  No

  N/A

• Add media

  Media

• Date of Audit

  Date

• Name of auditor

• Are all walking surfaces free of damaged flooring / cracked tiles / lifting carpet?

  Yes

  No

  N/A

• Is the room is neatly organized?

  Yes

  No

  N/A

• Have all fire extinguishers been inspected ? (Check tag to see if an inspection has been done in the past 12 months)

  Yes

  No

  N/A

• Are all ceiling tiles intact, undamaged and in place?

  Yes

  No

  N/A

• Are all overheard emergency exit signs undamaged and lit?

  Yes

  No

  N/A

• Is Emergency lighting in place and regularly tested for operational readiness? (Check with maintenance for operational readiness information)

  Yes

  No

  N/A

• Are all overhead sprinkler heads free and clear of obstruction (minimum 18 inches clearance)?

  Yes

  No

  N/A

• Is overhead lighting functional with no burnt-out lights?

  Yes

  No

  N/A

• No random chemicals (non-household) are present?

  Yes

  No

  N/A

• Add media

  Media

• Date of Audit

  Date

• Name of auditor

• Are all walking surfaces free of damaged flooring / cracked tiles / lifting carpet?

  Yes

  No

  N/A

• Are all general seating areas in good shape with no broken chairs or tables?

  Yes

  No

  N/A

• The general working area is neat, organized and free of tripping and/or falling hazards?

  Yes

  No

  N/A

• Is there minimum 36" in-between walkways and aisles?

  Yes

  No

  N/A

• Have all fire extinguishers been inspected ? (Check tag to see if an inspection has been done in the past 12 months)

  Yes

  No

  N/A

• Are all ceiling tiles intact, undamaged and in place?

  Yes

  No

  N/A

• Are all overheard emergency exit signs undamaged and lit?

  Yes

  No

  N/A

• Is Emergency lighting in place and regularly tested for operational readiness? (Check with maintenance for operational readiness information)

  Yes

  No

  N/A

• Are all overhead sprinkler heads free and clear of obstruction (minimum 18 inches clearance)?

  Yes

  No

  N/A

• Is overhead lighting functional with no burnt-out lights? (Check main passageways only)

  Yes

  No

  N/A

• Are all emergency doors free and clear of obstruction?

  Yes

  No

  N/A

• Are all glass panels free of damage?

  Yes

  No

  N/A

• No random chemicals (non-household) are present?

  Yes

  No

  N/A

Storage Rooms (Answer N/A to each question if no storage rooms are present in the zone)

• Is there is adequate lighting in the room?

  Yes

  No

  N/A

• If electrical panels are present, are they free of clutter 3' directly in front of them?

  Yes

  No

  N/A

• Is the room is neatly organized?

  Yes

  No

  N/A

Additional Notes / Hazards

• Add media

  Media

• Date of Audit

  Date

• Name of auditor

• Are all walking surfaces free of damaged flooring / cracked tiles / lifting carpet?

  Yes

  No

  N/A

• Are all general seating areas in good shape with no broken chairs or tables?

  Yes

  No

  N/A

• The general working area is neat, organized and free of tripping and/or falling hazards?

  Yes

  No

  N/A

• Is there minimum 36" in-between walkways and aisles?

  Yes

  No

  N/A

• Have all fire extinguishers been inspected ? (Check tag to see if an inspection has been done in the past 12 months)

  Yes

  No

  N/A

• Are all ceiling tiles intact, undamaged and in place?

  Yes

  No

  N/A

• Are all overheard emergency exit signs undamaged and lit?

  Yes

  No

  N/A

• Is Emergency lighting in place and regularly tested for operational readiness? (Check with maintenance for operational readiness information)

  Yes

  No

  N/A

• Are all overhead sprinkler heads free and clear of obstruction (minimum 18 inches clearance)?

  Yes

  No

  N/A

• Is overhead lighting functional with no burnt-out lights? (Check main passageways only)

  Yes

  No

  N/A

• Are all emergency doors free and clear of obstruction?

  Yes

  No

  N/A

• Are all glass panels free of damage?

  Yes

  No

  N/A

• No random chemicals (non-household) are present?

  Yes

  No

  N/A

Storage Rooms (Answer N/A to each question if no storage rooms are present in the zone)

• Is there is adequate lighting in the room?

  Yes

  No

  N/A

• If electrical panels are present, are they free of clutter 3' directly in front of them?

  Yes

  No

  N/A

• Is the room is neatly organized?

  Yes

  No

  N/A

Additional Notes / Hazards

• Add media

  Media

• Date of Audit

  Date

• Name of auditor

• Are all walking surfaces free of damaged flooring / cracked tiles / lifting carpet?

  Yes

  No

  N/A

• Are all general seating areas in good shape with no broken chairs or tables?

  Yes

  No

  N/A

• The general working area is neat, organized and free of tripping and/or falling hazards?

  Yes

  No

  N/A

• Is there minimum 36" in-between walkways and aisles?

  Yes

  No

  N/A

• Have all fire extinguishers been inspected ? (Check tag to see if an inspection has been done in the past 12 months)

  Yes

  No

  N/A

• Are all ceiling tiles intact, undamaged and in place?

  Yes

  No

  N/A

• Are all overheard emergency exit signs undamaged and lit?

  Yes

  No

  N/A

• Is Emergency lighting in place and regularly tested for operational readiness? (Check with maintenance for operational readiness information)

  Yes

  No

  N/A

• Are all overhead sprinkler heads free and clear of obstruction (minimum 18 inches clearance)?

  Yes

  No

  N/A

• Is overhead lighting functional with no burnt-out lights? (Check main passageways only)

  Yes

  No

  N/A

• Are all emergency doors free and clear of obstruction?

  Yes

  No

  N/A

• Are all glass panels free of damage?

  Yes

  No

  N/A

• No random chemicals (non-household) are present?

  Yes

  No

  N/A

Storage Rooms (Answer N/A to each question if no storage rooms are present in the zone)

• Is there is adequate lighting in the room?

  Yes

  No

  N/A

• If electrical panels are present, are they free of clutter 3' directly in front of them?

  Yes

  No

  N/A

• Is the room is neatly organized?

  Yes

  No

  N/A

Additional Notes / Hazards

• Add media

  Media

• Date of Audit

  Date

• Name of auditor

• Are all walking surfaces free of damaged flooring / cracked tiles / lifting carpet?

  Yes

  No

  N/A

• Are all general seating areas in good shape with no broken chairs or tables?

  Yes

  No

  N/A

• The general working area is neat, organized and free of tripping and/or falling hazards?

  Yes

  No

  N/A

• Is there minimum 36" in-between walkways and aisles?

  Yes

  No

  N/A

• Have all fire extinguishers been inspected ? (Check tag to see if an inspection has been done in the past 12 months)

  Yes

  No

  N/A

• Are all ceiling tiles intact, undamaged and in place?

  Yes

  No

  N/A

• Are all overheard emergency exit signs undamaged and lit?

  Yes

  No

  N/A

• Is Emergency lighting in place and regularly tested for operational readiness? (Check with maintenance for operational readiness information)

  Yes

  No

  N/A

• Are all overhead sprinkler heads free and clear of obstruction (minimum 18 inches clearance)?

  Yes

  No

  N/A

• Is overhead lighting functional with no burnt-out lights? (Check main passageways only)

  Yes

  No

  N/A

• Are all emergency doors free and clear of obstruction?

  Yes

  No

  N/A

• Are all glass panels free of damage?

  Yes

  No

  N/A

• No random chemicals (non-household) are present?

  Yes

  No

  N/A

Storage Rooms (Answer N/A to each question if no storage rooms are present in the zone)

• Is there is adequate lighting in the room?

  Yes

  No

  N/A

• If electrical panels are present, are they free of clutter 3' directly in front of them?

  Yes

  No

  N/A

• Is the room is neatly organized?

  Yes

  No

  N/A

Additional Notes / Hazards

• Add media

  Media

• Date of Audit

  Date

• Name of auditor

• Are all walking surfaces free of damaged flooring / cracked tiles / lifting carpet?

  Yes

  No

  N/A

• Are all general seating areas in good shape with no broken chairs or tables?

  Yes

  No

  N/A

• The general working area is neat, organized and free of tripping and/or falling hazards?

  Yes

  No

  N/A

• Is there minimum 36" in-between walkways and aisles?

  Yes

  No

  N/A

• Have all fire extinguishers been inspected ? (Check tag to see if an inspection has been done in the past 12 months)

  Yes

  No

  N/A

• Are all ceiling tiles intact, undamaged and in place?

  Yes

  No

  N/A

• Are all overheard emergency exit signs undamaged and lit?

  Yes

  No

  N/A

• Is Emergency lighting in place and regularly tested for operational readiness? (Check with maintenance for operational readiness information)

  Yes

  No

  N/A

• Are all overhead sprinkler heads free and clear of obstruction (minimum 18 inches clearance)?

  Yes

  No

  N/A

• Is overhead lighting functional with no burnt-out lights? (Check main passageways only)

  Yes

  No

  N/A

• Are all emergency doors free and clear of obstruction?

  Yes

  No

  N/A

• Are all glass panels free of damage?

  Yes

  No

  N/A

• No random chemicals (non-household) are present?

  Yes

  No

  N/A

Storage Rooms (Answer N/A to each question if no storage rooms are present in the zone)

• Is there is adequate lighting in the room?

  Yes

  No

  N/A

• If electrical panels are present, are they free of clutter 3' directly in front of them?

  Yes

  No

  N/A

• Is the room is neatly organized?

  Yes

  No

  N/A

Additional Notes / Hazards

• Add media

  Media

• Date of Audit

  Date

• Name of auditor

• Are all walking surfaces free of damaged flooring / cracked tiles / lifting carpet?

  Yes

  No

  N/A

• Are all general seating areas in good shape with no broken chairs or tables?

  Yes

  No

  N/A

• The general working area is neat, organized and free of tripping and/or falling hazards?

  Yes

  No

  N/A

• Is there minimum 36" in-between walkways and aisles?

  Yes

  No

  N/A

• Have all fire extinguishers been inspected ? (Check tag to see if an inspection has been done in the past 12 months)

  Yes

  No

  N/A

• Are all ceiling tiles intact, undamaged and in place?

  Yes

  No

  N/A

• Are all overheard emergency exit signs undamaged and lit?

  Yes

  No

  N/A

• Is Emergency lighting in place and regularly tested for operational readiness? (Check with maintenance for operational readiness information)

  Yes

  No

  N/A

• Are all overhead sprinkler heads free and clear of obstruction (minimum 18 inches clearance)?

  Yes

  No

  N/A

• Is overhead lighting functional with no burnt-out lights? (Check main passageways only)

  Yes

  No

  N/A

• Are all emergency doors free and clear of obstruction?

  Yes

  No

  N/A

• Are all glass panels free of damage?

  Yes

  No

  N/A

• No random chemicals (non-household) are present?

  Yes

  No

  N/A

Storage Rooms (Answer N/A to each question if no storage rooms are present in the zone)

• Is there is adequate lighting in the room?

  Yes

  No

  N/A

• If electrical panels are present, are they free of clutter 3' directly in front of them?

  Yes

  No

  N/A

• Is the room is neatly organized?

  Yes

  No

  N/A

Additional Notes / Hazards

• Add media

  Media

• Date of Audit

  Date

• Name of auditor

• Are all walking surfaces free of damaged flooring / cracked tiles / lifting carpet?

  Yes

  No

  N/A

• Are all general seating areas in good shape with no broken chairs or tables?

  Yes

  No

  N/A

• The general working area is neat, organized and free of tripping and/or falling hazards?

  Yes

  No

  N/A

• Is there minimum 36" in-between walkways and aisles?

  Yes

  No

  N/A

• Have all fire extinguishers been inspected ? (Check tag to see if an inspection has been done in the past 12 months)

  Yes

  No

  N/A

• Are all ceiling tiles intact, undamaged and in place?

  Yes

  No

  N/A

• Are all overheard emergency exit signs undamaged and lit?

  Yes

  No

  N/A

• Is Emergency lighting in place and regularly tested for operational readiness? (Check with maintenance for operational readiness information)

  Yes

  No

  N/A

• Are all overhead sprinkler heads free and clear of obstruction (minimum 18 inches clearance)?

  Yes

  No

  N/A

• Is overhead lighting functional with no burnt-out lights? (Check main passageways only)

  Yes

  No

  N/A

• Are all emergency doors free and clear of obstruction?

  Yes

  No

  N/A

• Are all glass panels free of damage?

  Yes

  No

  N/A

• No random chemicals (non-household) are present?

  Yes

  No

  N/A

Storage Rooms (Answer N/A to each question if no storage rooms are present in the zone)

• Is there is adequate lighting in the room?

  Yes

  No

  N/A

• If electrical panels are present, are they free of clutter 3' directly in front of them?

  Yes

  No

  N/A

• Is the room is neatly organized?

  Yes

  No

  N/A

Additional Notes / Hazards

• Add media

  Media

• Date of Audit

  Date

• Name of auditor

• Are all walking surfaces free of damaged flooring / cracked tiles / lifting carpet?

  Yes

  No

  N/A

• Are all general seating areas in good shape with no broken chairs or tables?

  Yes

  No

  N/A

• The general working area is neat, organized and free of tripping and/or falling hazards?

  Yes

  No

  N/A

• Is there minimum 36" in-between walkways and aisles?

  Yes

  No

  N/A

• Have all fire extinguishers been inspected ? (Check tag to see if an inspection has been done in the past 12 months)

  Yes

  No

  N/A

• Are all ceiling tiles intact, undamaged and in place?

  Yes

  No

  N/A

• Are all overheard emergency exit signs undamaged and lit?

  Yes

  No

  N/A

• Is Emergency lighting in place and regularly tested for operational readiness? (Check with maintenance for operational readiness information)

  Yes

  No

  N/A

• Are all overhead sprinkler heads free and clear of obstruction (minimum 18 inches clearance)?

  Yes

  No

  N/A

• Is overhead lighting functional with no burnt-out lights? (Check main passageways only)

  Yes

  No

  N/A

• Are all emergency doors free and clear of obstruction?

  Yes

  No

  N/A

• Are all glass panels free of damage?

  Yes

  No

  N/A

• No random chemicals (non-household) are present?

  Yes

  No

  N/A

Storage Rooms (Answer N/A to each question if no storage rooms are present in the zone)

• Is there is adequate lighting in the room?

  Yes

  No

  N/A

• If electrical panels are present, are they free of clutter 3' directly in front of them?

  Yes

  No

  N/A

• Is the room is neatly organized?

  Yes

  No

  N/A

Additional Notes / Hazards

• Add media

  Media

• Date of Audit

  Date

• Name of auditor

• Are all walking surfaces free of damaged flooring / cracked tiles / lifting carpet?

  Yes

  No

  N/A

• Are all general seating areas in good shape with no broken chairs or tables?

  Yes

  No

  N/A

• The general working area is neat, organized and free of tripping and/or falling hazards?

  Yes

  No

  N/A

• Is there minimum 36" in-between walkways and aisles?

  Yes

  No

  N/A

• Have all fire extinguishers been inspected ? (Check tag to see if an inspection has been done in the past 12 months)

  Yes

  No

  N/A

• Are all ceiling tiles intact, undamaged and in place?

  Yes

  No

  N/A

• Are all overheard emergency exit signs undamaged and lit?

  Yes

  No

  N/A

• Is Emergency lighting in place and regularly tested for operational readiness? (Check with maintenance for operational readiness information)

  Yes

  No

  N/A

• Are all overhead sprinkler heads free and clear of obstruction (minimum 18 inches clearance)?

  Yes

  No

  N/A

• Is overhead lighting functional with no burnt-out lights? (Check main passageways only)

  Yes

  No

  N/A

• Are all emergency doors free and clear of obstruction?

  Yes

  No

  N/A

• Are all glass panels free of damage?

  Yes

  No

  N/A

• No random chemicals (non-household) are present?

  Yes

  No

  N/A

Storage Rooms (Answer N/A to each question if no storage rooms are present in the zone)

• Is there is adequate lighting in the room?

  Yes

  No

  N/A

• If electrical panels are present, are they free of clutter 3' directly in front of them?

  Yes

  No

  N/A

• Is the room is neatly organized?

  Yes

  No

  N/A

Additional Notes / Hazards

• Add media

  Media

• Date of Audit

  Date

• Name of auditor

• Are all walking surfaces free of damaged flooring / cracked tiles / lifting carpet?

  Yes

  No

  N/A

• Are all general seating areas in good shape with no broken chairs or tables?

  Yes

  No

  N/A

• The general working area is neat, organized and free of tripping and/or falling hazards?

  Yes

  No

  N/A

• Is there minimum 36" in-between walkways and aisles?

  Yes

  No

  N/A

• Have all fire extinguishers been inspected ? (Check tag to see if an inspection has been done in the past 12 months)

  Yes

  No

  N/A

• Are all ceiling tiles intact, undamaged and in place?

  Yes

  No

  N/A

• Are all overheard emergency exit signs undamaged and lit?

  Yes

  No

  N/A

• Is Emergency lighting in place and regularly tested for operational readiness? (Check with maintenance for operational readiness information)

  Yes

  No

  N/A

• Are all overhead sprinkler heads free and clear of obstruction (minimum 18 inches clearance)?

  Yes

  No

  N/A

• Is overhead lighting functional with no burnt-out lights? (Check main passageways only)

  Yes

  No

  N/A

• Are all emergency doors free and clear of obstruction?

  Yes

  No

  N/A

• Are all glass panels free of damage?

  Yes

  No

  N/A

• No random chemicals (non-household) are present?

  Yes

  No

  N/A

Storage Rooms (Answer N/A to each question if no storage rooms are present in the zone)

• Is there is adequate lighting in the room?

  Yes

  No

  N/A

• If electrical panels are present, are they free of clutter 3' directly in front of them?

  Yes

  No

  N/A

• Is the room is neatly organized?

  Yes

  No

  N/A

Additional Notes / Hazards

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  Media