Title Page
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Service Center
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Conducted on
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Prepared by
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Location
Office
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Do any first aid kits have expired contents?
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What contents of the FAK are expired?
- Burn gel topical analgesic (6) 1/8 oz. packs
- Water gel sterile Burning dressing (1) 4"x4" Burn dressing
- Eyewash solution Sterile Buffered Eyewash
- Sting-Kill Swabs or wipes Topical Anesthetic
- Sting-Kill Swabs or wipes Topical Anesthetic
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What is the number of the FAK? If it does not have a number please assign it one, and note it's location.
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Are all the first aid kits complete?
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What contents of the FAK are missing?
- Bio-bag towels and wipes
- Body fluid cleanup absorbent
- Face mask with eye shield
- Gown
- Nitrile/Latex medical gloves
- Face mask rescue breather with one way valve
- 1"x3" adhesive bandages
- Triangle bandages
- Non-Adherent compress & Roller bandage
- Knuckle bands & fingertip bandages
- 4" Offset Compress
- Burn gel topical analgesic (6) 1/8 oz. packs
- Water gel sterile burning dressing (1) 4"x4" burn dressing
- Eyewash solution
- Sting kill wipes
- PVP iodine wipes
- Scissors and tweezers
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What is the number if the FAK? If it does not have a number, please assign it one.
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Are all Fire Extinguishers inspected monthly?
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Are all Fire Extinguishers inspected annually?
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What is the inspection date on the tag?
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What is the number of the fire extinguisher? If it does not have a number, please assign it one.
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Is the 16 tab binder up to date?
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What was the last date it was updated?
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Have all the employees that are domiciled on site, been trained on the contents of the binder?
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Is the "cheat sheet" (monthly schedule) in the front of the binder?
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Is the EAP binder up to date?
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What is the last date it was updated?
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Are there any light fixtures that are not working?
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Are there any surge protectors "Daisy Chained"?
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Are there any space heaters in the office area?
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Are there any exit signs that do not work?
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How is the housekeeping in the office?
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Is there a facility map by each exit with escape routes, shelter points, AED, and FAK?
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Is the SDS up to date?
Store Room/Shop
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Do any first aid kits have out of date contents?
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What contents of the FAK are expired?
- Burn gel topical analgesic (6) 1/8 oz. packs
- Water gel sterile Burning dressing (1) 4"x4" Burn dressing
- Eyewash solution Sterile Buffered Eyewash
- Sting-Kill Swabs or wipes Topical Anesthetic
- Sting-Kill Swabs or wipes Topical Anesthetic
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What is the number of the FAK? If it does not have a number please assign it one.
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Are the fire extinguishers inspected monthly?
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Are the fire extinguishers inspected annually?
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What is the Inspection date on the tag?
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What is the number of the fire extinguisher? If it does not have a number, please assign it one.
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Does all the shelving in the store room have a weight rating label attached?
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Which shelves do not have the weight label attached?
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Are all the trash cans labeled "Trash Only"?
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Is there a forklift training roster available?
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Are the daily forklift inspection forms available?
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Are the pallet jack inspections available?
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Have all the ladders and step stools been inspected monthly?
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Are all the flammable liquids stored in the flammable cabinet?
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Are all roll up doors labeled with maximum height signage?
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Are boxes stacked higher than 2 boxes high on the top shelf?
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Are there any slings that are frayed, or do no have a legible weight rating tag?
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Are all the fiberglass sticks within the 2 year test date?
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What is the test date on the stick?
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Is there signage by items weighing over 50lbs stating that help is needed for lifting of items 50lbs and over?
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Do the yellow lines on the floor need repainted?
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Is the forklift electric?
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Does the electric forklift have a designated charging area?
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Is the charging area marked on the floor and barricaded?
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Are there "No Smoking" and "Charging Area" signs in the charging area?
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Is there an eyewash station near?
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Is there any type of acid neutralizer in the immediate area?
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Is there a dry chemical, CO2 or foam fire extinguisher in the immediate area?
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Are there any pump up or back pack sprayers that need content labels?
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Are aerosol cans properly stored?
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Are the florescent bulbs stored correctly?
Yard
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Are wire reels chocked?
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Are trailers chocked?
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Are the poles in the pole pile stacked higher than the standards?
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Are there old poles laying in the yard that need to go in the dumpster?
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How is the housekeeping around the pole pile?
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Are the dumpsters labeled?
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What type of dumpster needs labeled?
- Wood only
- Metal only, No bulbs in light fixtures
- Trash only
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Do the dumpsters need to be emptied?
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Which dumpster needs emptied?
- Wood dumpster
- Metal dumpster
- Trash dumpster
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How is the housekeeping around the dumpster area?
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Which dumpster area needs housekeeping?
- Wood dumpster
- Metal dumpster
- Trash dumpster
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Are there rotten wire reels on the yard?
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How many reels?
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Are there rotten pallets on the yard?
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How many pallets?
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Do all of the 55 gallon barrels have labels of their contents?
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What type of labels are needed?
- Used bulbs
- Used oil
- New oil
- Empty
- Universal waste
- Oil filters
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Do the bulb barrels have a start date on them?
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Do the barrels need to be picked up by environmental?
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Which barrels need picked up?
- Used bulbs
- Used oil
- New oil
- Empty
- Universal waste
- Oil filters
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Are there any leaking transformers?
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Is the transformer in a spill containment bag?
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Are the B/O transformers labeled with the date they were taken out of service?
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Is there signage by items weighing over 50lbs stating that help is needed for lifting of items 50lbs and over?
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What is the condition of the perimeter fence?
Finalize Inspection
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Any remarks or comments for this inspection
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Items From Previous Audit Have Been Corrected
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Items From Previous Audit Were Observed And Have NOT Been Corrected
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By signing below I acknowledge that this inspection was completed to the best of my knowledge and abilities.
