Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Safety Representatives Monthly Inspection Report

Location

  • Location

  • Name of Inspector

  • Select date

STANDARD

  • 1.1 Structure, furniture, and equipment, in good condition and safe condition

  • 1.1 Floors- clean and free of dirt or other dangers

  • 1.2 Good lighting, natural or artificial?

  • 1.4 Rest room facilities-toilet,wash basins, clean and hygienic

  • 1.4 Kitchen lunchroom clean. No food in unauthorized areas.

  • 1.5 Pollution of air, water and ground

  • 1.5 Hazardous waste disposal in responsible manner.

  • 1.6 Areas demarcated.

  • 1.7 Stacking-stable, neat and safe.

  • 1.8 Areas inside and outside of building are neat and tidy. General housekeeping.

  • 1.9 Scrap and refuse bins enough and correctly placed.

  • 1.10 Color coding of pipes and plant in order.

  • 2.1 Machine guards in place

  • 2.2 All equipment/ hazards areas can be isolated / locked out and procedure displayed where applicable.

  • 2.3 Switches, isolator and valves labeled, outlets marked.

  • 2.4 Ladders, scaffolds and hand rails in good condition.

  • 2.5 Lifting gear in good condition.

  • 2.6 Gas cylinders and pressure vessels in order.

  • 2.7 Hazardous substances handled / stored using correct procedures.

  • 2.10 Portable electric equipment in good condition. No cords over floor.

  • 2.12 General electrical installations / flameproof Equipment is safe.

  • 2.13 Hand tools in good condition and properly stored.

  • 2.14 Ergonomics: conditions safe and confortable.

  • 2.18 Appropriate protective clothing / equipment available, properly utilized and in good condition.

  • 2.24 Safety signs and notices in place.

  • 3.1 Fire extinguishing equipment maintained and inspected.

  • 3.2 Location of fire extinguishers clearly visible, demarcated and unobstructed.

  • 3.3 Fire extinguishers in position.

  • 3.4 Flammable materials stored correctly.

  • 3.5 Alarm system working, employees aware of system.

  • 3.8 Emergency plan available and understood by staff.

  • 4.2 Injuries/accidents which occurred since previous inspection.

  • 5.6 Name of First Aiders displayed.

  • 5.19 Safe Work Procedures available and used.

General

Other Items not mentioned above:

  • Other item

Report by Inspector:

  • Does the report contain any major threat to the safety of any Employee?

  • If yes, complete the following:

  • Report by Inspector
  • The matter was reported as soon as practical?

  • Signature of Inspector:

  • To

  • Date Reported:

  • This Safety Information Report must be discussed with Manager/Supervisor as soon as possible.
    I have reviewed the inspection report and have been taken action on correcting the deviations noted.

  • Signature of Supervisor/Manager:

  • Date

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.