Citizens Ambulance Service Monthly Station Inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Safety Coordinator

• Location
  Address

• Personnel

Exterior Premises

• Sidewalks clear and free of slip/trip hazards.

  Yes

  No

  N/A

• Parking area clear of slip/trip hazards.

  Yes

  No

  N/A

• Exterior lighting in place and working.

  Yes

  No

  N/A

• Storage areas neat, clean and secure.

  Yes

  No

  N/A

General Building Condition

• Aisles and walkways clear of obstructions and trip hazards.

  Yes

  No

  N/A

• Stairs clear of obstructions and trip hazards

  Yes

  No

  N/A

• Doorways clear of obstructions and trip hazards

  Yes

  No

  N/A

• All doors open fully and easily.

  Yes

  No

  N/A

• Electrical outlets and extension cords not overloaded.

  Yes

  No

  N/A

• All electrical cords intact with no worn areas.

  Yes

  No

  N/A

• All power and equipment cords are secured out of the way of workers.

  Yes

  No

  N/A

• All lights in working condition.

  Yes

  No

  N/A

• Kitchen clean and fume hood filter clean.

  Yes

  No

  N/A

• Laundry facilities clean, working with no dirt buildup behind and lint trap clean.

  Yes

  No

  N/A

• All office chairs stable and working.

  Yes

  No

  N/A

• Filing cabinets are stable and marked with signs instructing users to open only one drawer at a time and close when not in use.

  Yes

  No

  N/A

• Safety/Training Board info current with old removed.

  Yes

  No

  N/A

Fire/Life Safety

• All exits properly marked and lights working.

  Yes

  No

  N/A

• All doors not an exit, marked "Not an Exit".

  Yes

  No

  N/A

• Evacuation routes posted by doors in all rooms.

  Yes

  No

  N/A

• Date of last evacuation drill?

• Emergency lighting systems working. (30 second test)

  Yes

  No

  N/A

• Carbon monoxide detectors tested and working.

  Yes

  No

  N/A

• Alarm systems including detectors tested and working.

  Yes

  No

  N/A

• All means of egress clear of clutter.

  Yes

  No

  N/A

• All doors open fully and easily.

  Yes

  No

  N/A

• All fire extinguishers fully charged and free of corrosion.

  Date

• Furnace and AC units checked and filters clean.

  Yes

  No

  N/A

Other

• Bay floors clean, dry and free of slip/trip hazards.

  Yes

  No

  N/A

• Eyewash station -clean, check and refill (change every three months).

  Date

• Indoor storage areas neat, clean and clutter free.

  Yes

  No

  N/A

• All secondary containers are properly labeled with hazards identified.

  Yes

  No

  N/A

• All chemical products in approved containers.

  Yes

  No

  N/A

• All ladders are clean, working properly and stored safely.

  Yes

  No

  N/A

• All unit disinfection logs are complete and turned in to be filed.

  Yes

  No

  N/A

• Deficiencies Noted

• Corrective actions taken.

• Coordinator signature

  Sign

• Manager signature

  Sign