Information

  • Property Name

  • Conducted on

  • Prepared by

  • Location
  • Persons present

Claim Info/Premise Security

Claim Information - Incident Reports

  • Are files available? Review and note any concerns or patterns.

  • Add media

Premise Security Liability

  • Is Key Control present? Note KeyTrac/Handy Trac/Manual.

  • Add media

  • If manual, is key log present?

  • Add media

  • Does property have a security program, onsite officers, patrol? Note vendor and if armed.

  • Add media

  • Does property have a security system? If monitored, note vendor.

  • Add media

  • Does property have cameras? Note if monitored.

  • Add media

  • Are cameras serviced regular? Note vendor.

  • Add media

  • Is property lighting adequate?

  • Add media

  • Does property have electronically controlled access gates or sidewalk gates? Note type of entry, i.e. gate fobs, cards, etc.

  • Add media

  • Is height of shrubs/trees such appropriately trimmed to limit hiding areas?

  • Add media

  • Are doors and windows secured?

  • Add media

  • Is property free of underground water wells?

  • Is property free of underground storage tanks?

Mold/Moisture

Mold Risk Exposures/Moisture

  • Does property have a mold/moisture policy or O&M program?

  • Does property have an abatement/remediation team?

  • Does property regularly schedule inspections for wet areas? Note any concerns.

  • Any chronic foundation and/or water infiltration issues? Note concerns.

  • Any evidence of chronic roof/gutter deficiencies? Note concerns.

  • Are vents cleaned regularly? Note any specific concerns.

  • Does property have bathroom exhaust fans?

  • Review log for mold/moisture records. Note specific concerns or patterns.

  • Is flow/site drainage adequate? Note concerns or deficiencies.

Fitness Center/Tanning Beds

Fitness Center

  • Is equipment in acceptable/safe condition. Note deficiencies or concerns.

  • Are cables in good condition? Note deficiencies, or concerns.

  • Are electrical power sources grounded?

  • Is fitness center free of trip hazards.? Note concerns.

  • Are outlets on GFI if water present?

  • Is entry secured/code functioning (if applicable)?

  • Are treadmills on 20 AMP dedicated circuit?

  • Does fitness center have appropriate signage? Rules, warnings, et.

Tanning Beds

  • Are all users required to sign waiver/release?

  • Does property have a sign in sheet? Does tanning bed have property signage?

  • Does property comply with local jurisdiction operator certification and licensing requirements? Note requirements.

  • Is disinfectant available?

  • Are goggles available?

Slip/Trip & Retaining Walls

Slip, Trip and Fall Hazards

  • Are carpets/rugs secured and free of trip hazards? (in all common areas)

  • Add media

  • Are bolts in stair treads secure and free of rust?

  • Add media

  • Are grounds maintained free of trip hazards, holes, uneven ground conditions?

  • Add media

  • Is parking lot free of holes, cracks and gaps?

  • Add media

  • Is property free of tiled or slick surfaces or are they appropriately marked when wet?

  • Add media

  • Are sidewalks/walk areas free of obstacles?

  • Add media

  • Are building numbers visible and lighted?

  • Add media

  • Is property free of oil and grease accumulations?

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  • Does property have adequate outside lighting, including parking, pathways, walkways, garages and carports?

  • Add media

Retaining Areas

  • Are rails present on all drop offs?

  • Add media

  • Are retaining areas free of exposed pipes?

  • Add media

  • Are all drain covers present and installed properly?

  • Add media

  • Are stairs free from crumbling, unsecured joints, and rust areas?

  • Add media

Fire / Winter Hazards

Fire Hazards

  • Is property free from exposed wiring?

  • Add media

  • Does property have a "no grills on patios" policy?

  • Add media

  • Are electrical outlets secured and free from electrical hazards?

  • Add media

  • Are flammables appropriately stored?

  • Add media

Fire Sprinkler System

  • Does property have fire sprinkler system? Note wet or dry.

  • Is system tested monthly or as required by manufacturer. Review test records, note last test.

  • Is system inspected annually? Note date of last inspection.

  • Is backflow inspected annually (or as required by local jurisdiction)? Note date of las inspection.

  • Is gylcol system present? Note any concerns.

  • Are closet heaters in working condition?

  • Are spare heads/tools available?

  • Is condition of riser rooms acceptable?

  • Are riser rooms accessible or locked- does it comply with local jurisdictional requirements?

  • Are 5-year gauges present and working?

  • Are isolation valves present and working?

  • Is fire pump in good condition?

  • Is fire pump fuel present if applicable?

  • Is a fire system generator present?

  • Note # of floors.

  • If dry system, is air compressor system present? Note any vendor/maintenance agreements.

  • Is property a mid-rise or high rise builidng?

  • Are exits marked?

  • Are emergency exit routes posted at elevators?

  • Is emergency lighting present and in working condition?

  • Are fire extinguishers present as required by local jurisdiction (in each unit or each building)?

  • Are fire extinguishers inspected annually or as required by local jurisdiction? Note date of last inspection.

Winter Hazards

  • Are exterior controls present to mitigate winter risks?

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  • Does the property have freeze/thaw and/or black ice condition potential (bridges, etc.)?

  • Add media

  • Are mopping and melt control procedures in place for interior space?

  • Add media

  • Are freeze sensors present on irrigation systems?

  • Add media

  • Does property have barricades and warning signage?

  • Add media

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  • Does property have appropriate equipment (snow plow, etc)?

  • Add media

  • Does property have contracts in place for snow/ice removal?

  • Add media

Pools / BBQ Areas / Sport or Tennis Court

Pools

  • Are permits present and up to date?

  • Is Emergency (911) Phone present and working?

Pool Safety

  • Is life ring with floating rope present and in good condition?

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  • Is shepherd's hook/fiberglass pole present and in good condition?

  • Add media

  • Does pool have emergency shutoff?

  • Add media

  • Does pool have approved drain covers (including spares) on site>

  • Add media

  • Is pool area free of trip hazards?

  • Add media

  • Are gates self locking, self closing?

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  • Are gate latches compliant with local height requirements (to prevent reach over)?

  • Add media

  • Are pool lights present and working?

  • Is pool fence in good condition, rust free?

  • Add media

  • Is fence free of stepholds?

  • Add media

  • Is pump room and seals in good condition?

  • Add media

  • Is electrical grounded in pump room?

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  • Are pressure gauges present ad in working condition?

  • Add media

  • Are flow meters present and in working condition?

  • Add media

  • Are all pipes labeled?

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  • Does property have appropriate chemical storage?

  • Add media

  • Is pump area properly secured?

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  • Does pump area have required signage (HazCom, employee only)?

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  • Does pump area have adequate ventilation?

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  • Is equipment in acceptable/safe condition?

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  • Is backwash operable?

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  • Is filter in acceptable condition?

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  • Is sand maintained properly? Note date of last change.

  • Is sight glass clear and in good condition?

  • Are Vac alerts present and in working condition?

  • Are vacumn breakers present and in working condition?

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  • Are GFCI's placed where needed/required?

  • Are steps/ladders in good condition?

  • Add media

  • Is tile/coping, interior of pool in good condition?

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  • Are depth markers/universal symbols present?

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  • Is belly band at 5'?

  • Is toe tile in good condition?

  • Add media

  • Are heater(s) in working condition?

  • Are heaters over 200,000 BTU's inspected? Note date of last inspection.

  • Are gas connections in good condition?

  • Add media

Does pool signage include:

  • No diving?

  • Pool Rules?

  • No lifeguard on duty?

  • Emergency Phone?

  • Emergency (911) phone directional signage?

  • Add media

Pool Furniture

  • Is furniture in good condition?

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  • Are frames stable and free of sharp edges?

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  • Are straps in good condition?

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  • Are umbrellas in proper bases?

  • Add media

BBQ Grills

  • Is fire extinguisher in close proximity?

  • Add media

  • Note whether gas, charcoal, propage.

  • Are grills on a shutoff timer?

  • Add media

  • Are shutoff's located away from grills?

  • Add media

  • Is overall condition acceptable? Grates, knobs, counters, burners, etc?

  • Add media

  • Is metal ash bucket present?

  • Add media

Sports/Tennis/Basketball Courts

  • Is appropriate signage present?

  • Add media

  • Is lighting appropriate and in working condition?

  • Add media

  • Are wind screens present and in good condition?

  • Add media

  • Are gates present and in good condition?

  • Add media

  • Is fencing in good condition?

  • Add media

  • Is decking in good condition?

  • Add media

Parking Structures

Parking Structures - Note type of structure (i.e. common concrete structure, attached individual garages, detached individual garages)

  • Is parking structure sprinklered? Note wet or dry system.

  • Does parking structure have carbon monoxide system? Adequate in and working condition?

  • Is parking structure a multiple-space concrete structure?

  • Is parking structure lighting adequate?

  • Are speed bumps in good condition?

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  • Does parking structure have adequate drainage?

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  • Are speed limit signs posted?

  • Is parking structure free of blind spots?

  • Is parking structure frame in good condition and free of rust?

  • Add media

  • Is decking in good condition?

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  • Is flashing present and in good condition?

  • Add media

  • Is striping/sealant in good condition?

  • Add media

  • Are barrier cables in good condition?

  • Add media

  • Is floor surface in good condition? Specify concrete or asphalt?

  • Add media

  • Is max height limit sign present and accurate?

  • Add media

  • Is structure free of any evidence of leaking on vehicles (check incident reports)?

  • Add media

  • Is transition are of garage to building appropriate?

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  • Is structure free of shifting issues and/or trip hazards?

  • Add media

  • Is structure free of any pedestrian hazards?

  • Is emergency lighting present and in working condition?

  • Is the structure clean and well maintained?

  • Add media

Trash Compactors

Compactor Areas

  • Does property have trash compactors?

  • Are compactors owned or leased?

  • Is appropriate signage present?

  • Add media

  • Are service records maintained? Note age of motor/manufacturer.

  • Are dumpster tracks in good condition?

  • Add media

  • Are dumpster wheels in good condition?

  • Note method of transport from trash chute to compactor, or compactor to pick up location. (manual/vehicle)

  • Is dumpster/compactor well maintained and in good condition?

  • Add media

  • Are enclosures present and in good condition?

  • Add media

  • Are electrical components free from hazards?

  • Is compactor motor well maintained an in working conditioin?

  • Are hoses adequate and in good condition?

  • Are fluids maintained? Note last inspection.

  • Is access limited to employees only?

  • Does compactor have start lockout for non-employees?

  • Is compactor area properly ventilated?

  • Is compactor area adequately lighted?

  • Has compactor been tested as required by manufacturer/city?

Trash Chutes

  • Does property have trash chutes?

  • Are fire doors in good condition and working properly?

  • Add media

  • Are chutes well maintained and clean? Do chutes have wash down system?

  • Are chutes sprinklered? (head and tail)

  • Are extinguishers present?

  • Are drains present?

  • Are doors free from damage?

  • Add media

Boilers

Boiler System

  • Does property have a boiler system?

  • Is access restricted to employees only and proper signs posted on entry door?

  • Is equipment well maintained and in working condition?

  • Is boiler room well maintained and in clean condition?

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  • Are boiler rooms free from debris (not used as storage, no flammables)?

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  • Is boiler room adequately ventilated?

  • Is emergency cutoff signage present?

  • Does property maintain an inspection log? Note date of last inspection.

  • Are permits up to date?

  • Is fire extinguisher present?

Safety - Preventative Maint - Tools - Cat Exposures

Safety Program

  • Does property currently have programs in place?

  • Does property have a MSDS books in all chemical storage areas and is it up to date?

Preventative Maintenance

  • Review preventative maintenance programs and note any concerns or deficiencies.

Tools

  • Request/Review inventory list that will convey.

  • Does property have fireproof safe/chemical storage?

  • Will golf carts convey? Note specific carts.

  • Are carts in good condition? Note concerns. (Brakes, tires, batteries, lights, horn, fire ext., chargers)

  • Add media

  • Are fiberglass ladders available?

  • Does property have a GFI extension cord?

  • Does property have an appliance dolly and will it convey?

  • Does property have a hot water heater lift set and will it convey?

PPE

  • Are back braces available?

  • Respirators and appropriate cartridges available?

  • Gloves available?

  • First aid kit present and stocked?

  • Add media

  • Eye wash kit available and stocked?

  • Add media

  • Goggles available?

  • Is rain gear available?

  • Is LOTO available and in use?

  • Are bloodborne pathogen kits available?

Catastrophe Exposures

  • Note earthquake exposure, if any.

  • Note flood hazard, if any.

  • Note hurricane exposure, if any.

  • Does property have emergency response in place?

  • Are emergency tools/equipment available?

Exterior - Playgrounds

Property Exterior

  • Is siding in good condition? Note type.

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  • Is stucco in good condition?

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  • Is masonry in good condition?

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  • Is siding/stucco free from tree/landscape damage or potential damage?

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  • Is siding/stucco free from any evidence of water intrusion at trim areas?

  • Add media

Wood Trim

  • Is wood trim in good condition and free from rot? Note concerns.

  • Add media

  • Any evidence of water damage present on trim?

  • Add media

  • Evidence of termites?

  • Add media

  • Evidence of carpenter ant damage?

  • Add media

Foundations

  • Any deficiencies? Note specific concerns.

  • Add media

  • Soil at acceptable levels?

  • Add media

  • Any cracks visible?

  • Add media

  • An exposed rebar?

  • Add media

Miscellaneous

  • Condition of electrical boxes acceptable?

  • Add media

  • Condition of cable boxes acceptable?

  • Add media

  • Site map of cutoffs available. Make copy.

  • Water cutoffs in good condition?

  • Add media

  • Condition of sewer clean outs acceptable?

  • Add media

  • Condition of electrical shutoffs acceptable?

  • Add media

  • Condition of gas shutoffs acceptable?

  • Add media

  • Is irrigation adequate and on separate meter?

  • Add media

  • Is property free from water pooling/low areas?

  • Add media

  • Are sidewalks in good condition, free of cracks and crumbles?

  • Add media

  • Is property free of metal or plastic edging at walk areas? Note locations

  • Add media

  • Are exterior storage areas free of damage?

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  • Is shop clean and organized? Stocked?

  • Add media

  • Are laundry rooms clean and vents free of lint?

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  • Are dog parks well maintained and free of hazards? Have proper signage?

  • Add media

  • Are fountains maintained and in working condition?

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  • Does property have exterior fencing?

  • Is fence in good repair?

  • Mail center available? Note condition of boxes and accessibility.

  • Car washes in good condition?

Playgrounds

  • Does property have a playground/playscape?

  • Is playground well maintained and in good condition? Note approximate age of equipment, last inspection.

  • Add media

  • Acceptable level of ground cover present?

  • Add media

  • Is appropriate signage present?

  • Add media

  • Is playground from any urgent safety concerns?

Roofing

Roofing

  • Is roof in good condition. Note approximate age.

  • Add media

  • Is decking in good condition?

  • Add media

  • Shingles in good condition? Note type of shingle.

  • Add media

  • Is siding in good condition?

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  • Are metal caps in good condition?

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  • Is flashing in good condition?

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  • Is roof edging in good condition?

  • Add media

  • Are gutters present and in good condition? Free of debris?

  • Add media

  • Are downspouts present and in good condition? Splash blocks present?

  • Add media

  • Free from visible tree rubs?

  • Add media

  • Does roof have adequate attic ventilation?

  • Add media

  • Are dryer vents installed and free of debris/lint?

  • Add media

  • Are ridge vents present and in acceptable condition?

  • Add media

  • Are soffit vents in acceptable condition?

  • Add media

  • Is attic access secure and for employees only?

  • Add media

  • Are chimney's in acceptable condition?

  • Add media

  • Does property conduct annual fireplace inspections? Note date of last inspection.

  • Add media

  • Is flashing in acceptable condition?

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  • Is roof free from water pooling?

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  • Does property have stairs/wall mounted ladders to roof? Note condition.

  • Add media

  • Are electrical disconnects/wiring for AC disconnects present, in good condition and secure?

  • Add media

  • Are electrical disconnects/wiring for AC disconnects in conduit?

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  • Are cable/TV antennae's sealed and mounted appropriately?

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  • Are any other items mounted or connected to roof?

  • Add media

Access Gates

Access Gates

  • Does property have access gates? Note how many.

  • Are knox locks present and in working condition?

  • Add media

  • Does each gate have indemnification signs posted?

  • Add media

  • Are gates free from exposed bolts or other hazards?

  • Add media

  • Are appropriate/required guards in place?

  • Add media

  • Is overall condition of gates acceptable?

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  • Are loop detectors present and in working condition?

  • Are safety eyes present and in working condition?

  • Are maintenance logs kept? Note last inspection.

  • Is a maintenance agreement in place for gates?

  • Note type and brand of opener (swing, rollup or slide)

  • Are appropriate permits in place, if applicable?

Confined Spaces

Confined Spaces

  • Identify all confines spaces (lift stations, meter vaults, etc.)

  • Are lift stations present?

  • Covers/secured?

  • Add media

  • Note Vendor/maintenance agreement.

  • Monitored? Note vendor.

Budget Items/Equipment

  • Metal glass cans

  • Face shields

  • Moisture meter

  • First aid kit

  • LOTO

  • Respirators

  • Chemical gloves

  • Hearing PPE

  • Cart caddy

  • Flammables cabinet

  • Fiberglass ladders

  • Appliance dolly

  • GFI extension cord

  • Back braces

  • Eye wash station

  • Signage -pool

  • Signage - boiler rooms

  • Signage-access gates

  • Signage - fitness center

  • Signage -cameras

  • Pool safety equipment-fiberglass shepherd hook

  • Pool safety - coast guard approved life ring with rope

  • 911 phone -working

  • Golf cart fire extinguishers

Summary

  • Does property have immediate repair concerns? List below.

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.