Title Page

  • Conducted on

  • Prepared by

  • Location

Reviewed Department

  • Which department are you reviewing?


  • Are exit doors blocked?

  • Are fire extinguishers available and charged?

  • Are fire extinguishers blocked?

  • Has the monthly fire extinguisher inspection been performed?

  • Is the eyewash station clean?

  • Is the eyewash station blocked?

  • Do aisles allow clear access to exit doors?

  • Is the emergency evacuation and shelter-in-place map posted in department?

  • Do team members know what to do during an evacuation?

  • Do team members know what to do during shelter-in-place?


  • Supervisor's Signature

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.