Title Page
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DLI Safety Observations Type OF Inspection
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Conducted on
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Prepared by
Electrical Safety Observations
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Panels Clear of Obstructions
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Panels Blocked
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Electrical doors closed
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Electrical Equipment Free of Damage
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Electrical Equipment Damaged
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Voltage Labels on Electrical Boxes
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Voltage Labels on Electrical Boxes MISSING
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Arc Flash Labels on Electrical Boxes
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Arc Flash Labels on Electrical Boxes MISSING
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Exit Lights Good Working Order
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Exit Lights Not Working
General Safety
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Employees not using their phone while working or operation equipment
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Employees using their phone while working or operation equipment
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Forklift and other Mobile Equipment Inspections Completed
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Forklift and other Mobile Equipment Inspections NOT Completed
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Fire Equipment Accessible
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Fire Equipment NOT Accessible
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Chemicals Properly Labeled
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Chemicals MISSING Labels
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Employees Wearing Safety Glasses
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Employees NOT Wearing Safety Glasses
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Employees Wearing Hearing Protection
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Employees NOT Wearing Hearing Protection
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Tools in Good Condition
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Tools Broken or Improperly Modified
Housekeeping
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Aisles are clear of Obstacles
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Aisles are BLOCKED
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All Drinking Container Tops are Properly Closed
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All Drinking Container Tops with an Open Top
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Trash Containers not overflowing
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Trash Containers overflowing that need to be emptied
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Food not found in the employee area were chemicals are being used
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Food in Found in the Work Areas where chemicals are being used, Inks, solvents, cleaning supplies