Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

  • Adequate and functioning lighting provided in all work areas

  • VRC/Elevator(s) functioning properly

  • Work areas free of tripping hazards (cords/wires, free-standing electrical fixtures, etc.)

  • Warning signs and/or mats provided when floors are wet

  • Furniture (e.g. desks, chairs, filing cabinets) in good and safe condition?

  • Overhead storage utilized properly, so as not to create unsafe work environments

  • Basic First Aid supplies adequate

  • Staff lounge and eating areas clean and sanitary

  • Manual Handling aides are available and used

  • Minimum 18' clearance below sprinkler heads

  • Areas surrounding the electrical panel(s) free of flammable, hazardous, combustible material

  • All employee lounge areas free of any visual evidence of a fire hazard or violation (Please document any specific concerns in the "Comment" section below)


  • Any other comments?

  • When completed please provide signature here:

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.