Information

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location

Lobby Area

  • Is entry area glass display wiped clean?

  • Is entryway floor surface clean?

  • Is entryway floor surface safe to walk on? (Dry, level, zero cracks, free from objects that would be a trip hazard etc...)

  • Are walls dirt and smudge free?

  • Is any bright work polished and smudge free?

  • Kick plates on all doors polished and smudge free?

  • All corners dust and debris free?

  • Are the baseboards clean?

  • Are overhead and wall vents clean?

  • Are all light fixtures dust free and clean?

  • Are all light bulbs lit?

  • Are all signs / artwork straight and clean?

  • Spider webs been removed from windows, corners, furniture, walls?

  • Is all furniture clean?

  • Is there dust in high level areas?

  • Is there dust in medium level areas?

  • Is there dust in low level areas?

Common Area Corridors

  • Are carpets thoroughly vacuumed and free of dust, dirt, or debris?

  • Corners dust and debris free?

  • Walls dirt and smudge free?

  • Bright work polished and smudge free?

  • Kick plates on all doors polished and smudge free?

  • Spider webs been removed from windows, corners, furniture, walls?

  • Are tables clean?

  • Are task chairs clean?

  • Is there dust in high level areas?

  • Is there dust in medium level areas?

  • Is there dust in low level areas?

Stairwells

  • Are all the stair treads present and in good repair with no loose trim or other components?

  • Are all the lights in the stairwell functional?

  • Are the stairwells clean and dry?

  • Are the stairwells odor free?

  • Are the stairs free of any objects both on top and below them that could present a trip or fire hazard? (boxes of paper goods, brooms, mops, pens, pencils, rags etc...)

  • Are all EXIT signs present and lit?

Elevators / Escalators

  • Are door tracks to elevators free of dust, dirt, or debris?

  • Are cab walls dirt and smudge free?

  • Is all bright work (stainless steel) polished and smudge free?

  • All corners dust and debris free?

  • Lights and covers present and functional?

  • Is there litter above ceiling grid?

Executive Area

  • Is entry area glass display wiped clean?

  • Is entry carpet clean?

  • Are walls dirt and smudge free?

  • Is any bright work polished and smudge free?

  • Kick plates on all doors polished and smudge free?

  • All corners dust and debris free?

  • Are the baseboards clean?

  • Are overhead and wall vents clean?

  • Are all light fixtures dust free and clean?

  • Are all signs / artwork straight and clean?

  • Spider webs been removed from windows, corners, furniture, walls?

  • Are task chairs clean?

  • Refrigerator clean and defrosted?

  • Are tables clean?

  • Is there dust in high level areas?

  • Is there dust in medium level areas?

  • Is there dust in low level areas?

Men’s Restrooms

  • Are entry and exit doors wiped clean inside and out?

  • Kick plates on door (inside and out) polished and smudge free?

  • Are floors clean and dry?

  • Base of toilet(s) clean and dry?

  • Corners free of dirt and debris?

  • Walls and baseboards dirt and smudge free?

  • All bright work polished and smudge free?

  • Is there adequate toilet tissue (1 full roll minimum) in the toilet stall(s)?

  • Underside of the toilet seat clean?

  • All vents clean?

  • Stall walls, door, and top edges clean and dust free?

  • Hand sinks faucets clean? (check for hard water build up)

  • Are dispensers stocked with soap or paper products?

  • Is floor under wash sink(s) clean and dry?

  • Is the area directly under the soap dispenser clean and soap free?

  • Are trashcan(s) large enough?

  • Is there an extra trash liner?

  • Is the mirror dust, streak and smudge free?

  • Are work orders called in for any broken or missing items?

  • Soap dispensers are full and functional?

  • Is there dust in medium level areas?

  • Is there dust in high level areas?

  • Is there dust in low level areas?

Women's Restrooms

  • Are entry and exit doors wiped clean inside and out?

  • Kick plates on door (inside and out) polished and smudge free?

  • Are floors clean and dry?

  • Base of toilet(s) clean and dry?

  • Corners dirt and debris free?

  • Walls and baseboards dirt and smudge free?

  • All bright work polished and smudge free?

  • Is there adequate toilet tissue (1 full roll minimum) in the toilet stall(s)?

  • Underside of the toilet seat clean?

  • All vents clean?

  • Stall walls, door, and top edges clean and dust free?

  • Hand sinks faucets clean? (check for hard water build up)

  • Are dispensers stocked with soap or paper products?

  • Is floor under wash sink(s) clean and dry?

  • Is the area directly under the soap dispenser clean and soap free?

  • Are trashcan(s) overfull?

  • All vents clean?

  • Stall walls, door, and top edges clean and dust free?

  • Is the mirror dust, streak and smudge free?

  • Are work orders called in for any broken or missing items?

  • Is feminine napkin dispenser working?

  • Is feminine napkin disposal container clean and does it have a liner?

  • Is there dust in high level areas?

  • Is there dust in medium level areas?

  • Is there dust in low level areas?

Office / Cubicle Areas

  • Is entry door glass wiped clean inside and out?

  • Is entry carpet clean?

  • Are walls dirt and smudge free?

  • Is any bright work polished and smudge free?

  • Kick plates on all doors polished and smudge free?

  • All corners dust and debris free?

  • Are the baseboards clean?

  • Are overhead and wall vents clean?

  • Are the walls smudge free and clean?

  • Are all light fixtures dust free and clean?

  •   Are all signs / artwork straight and clean?

  • Spider webs been removed from windows, corners, furniture, walls?

  • Cubicle wall tops dust free?

  • Is the general appearance of the room (area) clean?

  • Is there dust in high level areas?

  • Is there dust in medium level areas?

  • Is there dust in low level areas?

Conference Rooms

  • Are entry way doors clean and or polished and door jambs clean?

  • Is the floor vacuumed and free of dust and/or debris?

  • Are the walls clean and free of smudge marks?

  • Have all the trashcans been emptied as required?

  • Are all trash can liners in good condition?

  • Have carpet spots been removed as required?

  • Are all the ceiling or wall vents and diffusers clean?

  • Is the conference room table(s) clean and polished?

  • Are all the conference room chairs clean?

  • Are the window sills and blinds clean?

  • Are whiteboards clean?

  • Is the overall appearance of the room clean and ready for a meeting?

  • Is there dust in high level areas?

  • Is there dust in medium level areas?

  • Is there dust in low level areas?

Vending / Break Room Areas

  • Are microwaves clean and functional?

  • Are walls clean, smudge, and dust free?

  • Bright work and sinks wiped clean and smudge free?

  • Countertop and cabinets clean and smudge free?

  • Corners of countertop dust and debris free?

  • Are cleaning chemicals present and properly stored and labeled?

  • Are coffee machines and/or air pots clean?

  • Floor clean, mopped and streak free, or vacuumed with all spots removed?

  • Corners clean and free of debris and dust?

  • Are paper towels stocked?

  • Are refrigerators clean w/proper signage?

Cafeteria / Dining Room Area

  • Are serving areas clean and functional?

  • Are walls clean, smudge, and dust free?

  • Bright work and sinks wiped clean and smudge free?

  • Are the countertops, tables and chairs clean and smudge free?

  • Corners of countertop dust and debris free?

  • Is carpeting spot free?

Fitness Center

  • Exercise equipment clean?

  • Are entry and exit doors wiped clean inside and out?

  • Kick plates on door (inside and out) polished and smudge free?

  • Are floors clean and dry?

  • Base of toilet(s) clean and dry?

  • Corners dirt and debris free?

  • Walls and baseboards dirt and smudge free?

  • All bright work polished and smudge free?

  • Hand sinks faucets clean? (check for hard water build up)

  • Soap dispensers are full and functional?

  • Are dispensers stocked with soap or paper products?

  • Is there adequate toilet tissue (1 full roll minimum) in the toilet stall(s)?

  • Is the area directly under the soap dispenser clean and soap free?

  • Is floor under wash sink(s) clean and dry?

  • All vents clean?

  • Stall walls, door, and top edges clean and dust free?

  • Are showers clean and free of mold?

  • Do trashcan(s) have adequate capacity?

  • Is the mirror dust, streak and smudge free?

  • Are work orders called in for any broken or missing items?

  • Is feminine napkin dispenser working?

  • Is feminine napkin disposal container clean and does it have a liner?

  • Is there dust in high level areas?

  • Is there dust in medium level areas?

  • Is there dust in low level areas?

Housekeeping Closets

  • Are the chemical storage containers labeled properly?

  • Are cleaning chemicals stored in a neat and orderly manner?

  • Are storage shelves organized and neat?

  • Are goggles and rubber gloves evident?

  • Is there a functional eyewash station with unimpeded access within 10 feet of any chemical mixing stations?

  • Is equipment stored correctly and in good repair?

  • Are “Wet Floor” signs and Safety Cones available?

  • Is the floor clean and mop basin or sink clean?

  • Are the housekeeping carts clean, fully stocked, and neatly organized?

  • Is the general appearance of the housekeeping room(s) neat and orderly?

Mechanical Rooms

  • Are any chemical storage containers labeled properly?

  • Is any air filter inventory stored in a neat and orderly manner?

  • Are emergency shutoff devices clearly labeled?

  • Are storage shelves organized and neat?

  • Is equipment stored correctly and in good repair?

  • Is the general appearance of the mechanical room(s) neat and orderly?

  • Are goggles and rubber gloves present near the water testing station?

  • Is an eyewash station within 10 unimpeded feet of any caustic water treatment or testing chemicals?

Maintenance Shops / Workbenches

  • Do the bench grinder tool rest gaps meet the current OSHA standard?

  • Are ladders inspected per the ladder safety standard?

  • Are all extension cords compliant regarding ground pin and double insulation present?

  • Do all power tools have undamaged double insulated cords?

  • Is appropriate PPE easily accessible for all activities?

  • Is the general appearance of the maintenance shop and workbench(es) neat and orderly?

  • Are all flammables stored in a FLAMMABLE cabinet?

  • Are all acids stored in an ACID cabinet?

  • Are all gas cylinders chained upright and all oxidizers stored separately from flammables?

Electrical Rooms

  • Is the area in front of electrical panels clear for a minimum depth of three feet in front and a minimum width of the width of the equipment or 2.5 feet, whichever is greater?

  • Is the room containing the electrical panels secured in such a way that only authorized individuals can access the space?

  • Are the electric panels clearly marked with "arc flash" labels?

  • Are all panel enclosures in place and properly secured? (no energized wiring showing)

  • Are the floors, walls and ceiling clean and dry without any evidence of water infiltration into the room?

Data Closets / Data Center

  • Is the room containing the data equipment secured in such a way that only authorized individuals can access the space?

  • Are all of the floor panels in place?

  • Is all wiring bundled properly and not strewn across the floor?

  • Is the HVAC system functioning and maintaining the ambient temperature within standard?

Facility Exterior

  • Exterior sheathing and trim all present with no breeches?

  • Exterior lights all functioning?

  • Windows intact and sealed?

  • Doors all functional?

  • Roofing material present and functional?

  • Roof drains functional with no ponding present?

Parking Areas / Ramps

  • Lights all functional?

  • Drains functional?

  • Strobe and traffic lights functional?

  • Traffic control signage present and legible?

  • Are fire lanes clearly marked and signage and curb paint clearly legible?

  • Are pedestrian walkways clearly marked with signage and painted crosswalks?

  • Are handicap stalls present with legible signage and paint?

  • Corners free of debris and litter?

  • Is there any vegetation growing in cracks?

  • Are the parking lot surfaces sealed?

  • Stairwells are clean and odor free?

  • Ramps and parking areas are free of litter / cigarette butts?

  • Ramp roof sealed with no leaks?

  • Snow removed?

  • Sufficient salt applied for safe driving surface, especially at intersections?

Sidewalks / Grounds / Hardscape

  • Are sidewalks clean?

  • Are sidewalks free of vegetation?

  • Are sidewalks level (frost heaves ground down)?

  • Are flagpoles functional?

  • Are water features clean and functional?

  • Are picnic area and other hardscape features clean and functional?

  • Are ash trays present and large enough in designated smoking areas?

  • Are lights functional?

  • Do all security cameras have clear lines of sight through their field of view?

  • Are ash trays present near entrances?

  • Are fire hydrants and POV valves visible and easily accessible?

  • Has sufficient salt been applied to create a safe walking surface, particularly around main entrances?

Landscaping

  • Is the grass uniformly green?

  • Is the sprinkler system functional?

  • Is the grass an acceptable height?

  • Is the lawn edged properly?

  • Are weeds controlled sufficiently?

  • Are perennials properly pruned?

  • Are trees properly trimmed?

  • Is sufficient mulch in place?

  • Are grass clipping present on sidewalks, parking lots or other inappropriate locations?

  • Is litter all removed from the landscaping?

  • Are annual plantings appropriately colorful?

Exterior Signage

  • Is signage legible?

  • Is the entire sign lit at night?

  • Is the dawn/dusk timer or light sensor operational?

  • Is the signage the appropriate color(s)?

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.