Environmental/Follow-up/3rd Shift Inspection

• Add location
  Address

• Conducted on

  Date

• Prepared by Kermit Thomas Safety Coordinator

• Sent to:

Exterior

• Driveway and paths in good condition, no trip hazards?

  N/A

  Good

  Poor

  Fix or Replace

• Door handles, locks and lighting in good working order?

  N/A

  Good

  Poor

  Fix or Replace

General Shared Areas

• Internal doors, hinges and locks in working order?

  N/A

  Good

  Poor

  Fix or Replace

• Flooring, clear of hazards?

  N/A

  Good

  Poor

  Fix or Replace

• Paint in good conditions (no chips, marking or discoloration)?

  N/A

  Good

  Poor

  Fix or Replace

• Lighting and switches?

  N/A

  Good

  Poor

  Fix or Replace

• Furniture safe and undamaged?

  N/A

  Good

  Poor

  Fix or Replace

• Walls free of holes or cracks?

  N/A

  Good

  Poor

  Fix or Replace

• Handrails present, safe and secure?

  N/A

  Good

  Poor

  Fix or Replace

• Evidence of pests?

  Yes

  No

Kitchens

• Condition of faucets?

  N/A

  Good

  Poor

  Fix or Replace

• Condition of Kitchen cabinets and work surfaces?

  N/A

  Good

  Poor

  Fix or Replace

• Fridge and seals condition?

  N/A

  Good

  Poor

  Fix or Replace

• Drains (floor and sink)?

  N/A

  Good

  Poor

  Fix or Replace

• Dishwasher

  N/A

  Good

  Poor

  Fix or Replace

• Oven

  N/A

  Good

  Poor

  Fix or Replace

• Cooktop

  N/A

  Good

  Poor

  Fix or Replace

• Rangehood and vents

  N/A

  Good

  Poor

  Fix or Replace

Bathrooms

• Toilet & seats

  N/A

  Good

  Poor

  Fix or Replace

• Sinks, tubs, showers

  N/A

  Good

  Poor

  Fix or Replace

• Faucets, shower heads

  N/A

  Good

  Poor

  Fix or Replace

Laundry

• Floor/area free from water

  N/A

  Good

  Poor

  Fix or Replace

• Dryer lint

  N/A

  Good

  Poor

  Fix or Replace

Emergency

• Access and paths are clear and even?<br>

  Yes

  No

  N/A

• Emergency lights operational?

  Yes

  No

  N/A

• Fire extinguishers (hung, charged and signed off)?

  Yes

  No

  N/A

• Fire Blankets easily accessible in kitchen?

  Yes

  No

  N/A

• Emergency kit in safe room?

  Yes

  No

  N/A

• First aid kit accessible?

  Yes

  No

  N/A

• COVID PPE (N95 masks, face shields and isolation gowns) readily accessible for after-hours cases?

  Yes

  No

  N/A

Miscellaneous

• Are there any visible hazards?

  Yes

  No

• Is the admin area ergonomically safe?

  Yes

  No

  N/A

Sign Off

• Employee signature

  Sign

• Name of Employee

• Inspector's signature

  Sign

• Kermit Thomas Safety Coordinator

  Drawing