Title Page

  • Client / Site

  • Location
  • Conducted on

  • Prepared by

General Safety

  • Are chairs and other furniture in good condition?

  • Are all compressed gas cylinders that may be in your area secured from falling over?

  • During the survey, were all staff observed using proper body mechanics?

  • In areas where items are stored or placed overhead, is there ready access to a suitable step stool, stepladder, or similar device?

  • In storage areas, are the heavier items stored at waist level, with the lightest objects placed on the higher shelves?

  • Are all vehicles (carts, wheelchairs, etc.) in good operating condition?

  • Has personal protection equipment (as required by MSDS or other standards) been provided to all employees needing it?

  • Is the area free of clutter?

  • Is excess paper and combustible material improperly stored creating a fire risk?

Fire & Disaster

  • Are all fire alarm pull stations and fire extinguishers accessible?

  • Does all staff know the locations of fire alarm pull stations?

  • Does all staff know the locations of extinguishers in or near their work area?

  • All portable fire extinguishers are regularly serviced?

  • Fire hoses/ Reels are sealed, operable and not used for daily operations?

  • Does staff in the area know the proper reporting procedure if they find (or believe there may be) a fire?

  • Is all stock kept stacked in such a way that it is not to close to light fixtures and pallets stack at a maximum of 2 pallets?

  • Are all containers liquids (chemicals) labeled as to contents?

  • Are all areas in compliance with “No Smoking” policies?

  • when heaters are used, are they approved and do not pose a safety hazard?

Hallways, Stairs, & Exit Paths

  • Are the corridors kept clear of obstructions?

  • Are all wet floors marked with "CAUTION, WET FLOOR" (or similar) signs?

  • Is carpeting secure to the floor, unfrayed, free from tripping hazards, and generally in good condition?

  • Are hard floor surfaces secure and free of tripping and slipping hazards?

  • Are floor surfaces uneven or in need of repair?

  • Are all EXIT signs illuminated?

  • When opened and then released, do all fire doors close and latch properly?

  • Are stairwell handrails in good condition?

  • Are stair treads in good condition?

  • Are stairwells completely clear of obstructions and any objects?

  • Is the housekeeping in this area adequate?

  • Is access to electrical panels clear and not obstructed?

  • Are all electrical switches & circuit breakers identified? If not, list the locations of those that are not on the back of this sheet.

  • Are all electrical receptacles and cover plates in good condition?

  • Are electrical cords and plugs in good condition?

  • Check for damaged insulation, cut cords, splices, and tape wrapped around the cord - none of which should be present.

  • Are only fused power strip extension cords, surge protectors, used (all 3 pins on the plug)?

  • Does all electrical equipment in the area appear to be in good condition?

Electrical Safety

  • Is access to electrical panels clear and not obstructed?

  • Are all electrical switches & circuit breakers identified? If not, list the locations of those that are not on the back of this sheet.

  • Are all electrical receptacles and cover plates in good condition?

  • Are electrical cords and plugs in good condition? Check for damaged insulation, cut cords, splices, and tape wrapped around the cord - none of which should be present.

  • Are only fused power strip extension cords, surge protectors, used (all 3 pins on the plug)?

  • Does all electrical equipment in the area appear to be in good condition?

First Aid

  • Are cabinets and contents clean, orderly and properly stocked?

  • Are first aid kits accessible and the first aid officers identified?

  • Do staff know the location of the first aid kits?

  • Emergency drills held every 6 months?

Forklifts

  • Daily inspections available and signed off by Management?

  • Charging area clean and in good condition?

  • Charging unit adequate ventilation?

  • Charging unit connection in good repair?

Completion

  • Recommendations

  • Full Name and Signature of the Inspector

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.