Diablo Monthly Facilities Maintenance Check

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Personnel

1.0 - Previous inspection

• 1.1 - Has the last inspection been reviewed?

  Yes

  No

  N/A

• 1.2 - Are there no outstanding actions?

  Yes

  No

  N/A

2.0 - Office/Break Room Conditions

• 2.1 - Carpet Condition

  Good

  Fair

  Poor

  N/A

• 2.2 - Tile Condition

  Good

  Fair

  Poor

  N/A

• 2.3 - Covebase/Baseboard Condition

  Good

  Fair

  Poor

  N/A

• 2.4 - Area Rug Condition

  Good

  Fair

  Poor

  N/A

• 2.5 - Heat/Cooling System Condition - Record Temperature:

  Good

  Fair

  Poor

  N/A

• 2.6 - Equipment Condition

  Good

  Fair

  Poor

  N/A

• 2.7 - Lighting Condition

  Good

  Fair

  Poor

  N/A

• 2.8 - Emergency Lighting Condition

  Good

  Fair

  Poor

  N/A

• 2.9 - Condition of Walls

  Good

  Fair

  Poor

  N/A

• 2.10 - Condition of Ceilings/Vents/Air Return Duct

  Good

  Fair

  Poor

  N/A

• 2.11 - Condition of Doors

  Good

  Fair

  Poor

  N/A

• 2.12 - Condition of Fire Extinguishers

  Good

  Fair

  Poor

  N/A

• 2.13 - Condition of Sink - Record Water Temperture

  Good

  Fair

  Poor

  N/A

• 2.14 - Bubbler/Water Cooler Condition

  Good

  Fair

  Poor

  N/A

• 2.15 - Condition of Windows

  Good

  Fair

  Poor

  N/A

• 2.16 - Condition of Blinds / Shades

  Good

  Fair

  Poor

  N/A

• 2.17 - Condition of Storage Cabinets

  Good

  Fair

  Poor

  N/A

• 2.18 - Condition of Desk Shelving Units

  Good

  Fair

  Poor

  N/A

• 2.19 - Condition of Exit Signs

  Good

  Fair

  Poor

  N/A

• 2.20 - Outlet Cover Condition

  Good

  Fair

  Poor

  N/A

3.0 - Bathroom

• 3.1 - Tile Condition

  Good

  Fair

  Poor

  N/A

• 3.2 - Covebase/Baseboard Condition

  Good

  Fair

  Poor

  N/A

• 3.3 - Condition of Walls

  Good

  Fair

  Poor

  N/A

• 3.4 - Lighting Condition

  Good

  Fair

  Poor

  N/A

• 3.5 - Condition of Ceilings/Vents/Air ReturnDuct

  Good

  Fair

  Poor

  N/A

• 3.6 - Condition of Doors

  Good

  Fair

  Poor

  N/A

• 3.7 - Condition of Sink - Record Water Temperature

  Good

  Fair

  Poor

  N/A

• 3.8 - Condition of Toilet/Urinal

  Good

  Fair

  Poor

  N/A

• 3.9 - Bathroom Cleaned

  Good

  Fair

  Poor

  N/A

Racking

• 4.1 - Condition of Uprights

  Safe

  At Risk

  N/A

• 4.2 - Condition of Beams

  Safe

  At Risk

  N/A

• 4.3 - Condition of Backstop

  Safe

  At Risk

  N/A

• 4.4 - Condition of Pallet Supports

  Safe

  At Risk

  N/A

• 4.5 - Pallets Stored Correctly

  Safe

  At Risk

  N/A

Warehouse

• 5.1 - Condition of Floor

  Good

  Fair

  Poor

  N/A

• 5.2 - Condition of Walls

  Good

  Fair

  Poor

  N/A

• 5.3 - Condition of Support Columns

  Good

  Fair

  Poor

  N/A

• 5.4 - Condition of Shipping Dock Doors

  Good

  Fair

  Poor

  N/A

• 5.5 - Condition of Shipping Dock Levelers

  Good

  Fair

  Poor

  N/A

• 5.6 - Condition of Doors

  Good

  Fair

  Poor

  N/A

• 5.7 - Condition of Driver Cages

  Good

  Fair

  Poor

  N/A

• 5.8 - Condition of Emergency Lighting

  Good

  Fair

  Poor

  N/A

• 5.9 - Condition of Exit Lights

  Good

  Fair

  Poor

  N/A

• 5.10 - Condition of Fire Extinguishers

  Good

  Fair

  Poor

  N/A

• 5.11 - Condition of Eye Wash Station (Run Water Through Plumed Station)

  Good

  Fair

  Poor

  N/A

• 5.12 - Condition of Equipment

  Good

  Fair

  Poor

  N/A

• 5.13 - Condition of Outlets

  Good

  Fair

  Poor

  N/A

• 5.14 - Condition of Lighting

  Good

  Fair

  Poor

  N/A

• 5.15 - Condition of HVAC Systems

  Good

  Fair

  Poor

  N/A

• 5.16 - Condition of Fans

  Good

  Fair

  Poor

  N/A

• 5.17 - Condition of Plugs and Wires

  Good

  Fair

  Poor

  N/A

Sign Off

• Inspector's Signature

  Sign