Emergency Preparedness

• Conducted on

  Date

• Prepared by

• Location
  Address

Reviewed Department

• Which department are you reviewing?

  Select Frame Floor Wall Top Electrical Exterior Front Door Moulding Final Finish Shipping/Receiving Cabinet

  • Frame
  • Floor
  • Wall
  • Top
  • Electrical
  • Exterior
  • Front Door
  • Moulding
  • Final Finish
  • Shipping/Receiving
  • Cabinet

Housekeeping

• Are exit doors blocked?

  Safe

  At Risk

  N/A

• Are fire extinguishers available and charged?

  Safe

  At Risk

  N/A

• Are fire extinguishers blocked?

  Safe

  At Risk

  N/A

• Has the monthly fire extinguisher inspection been performed?

  Safe

  At Risk

  N/A

• Is the eyewash station clean?

  Safe

  At Risk

  N/A

• Is the eyewash station blocked?

  Safe

  At Risk

  N/A

• Do aisles allow clear access to exit doors?

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

Signature

• Supervisor's Signature

  Sign