Facilities & Safety Inspection

• Conducted on

  Date

• Prepared by

• Location
  Address

Life Safety/Emergency Response & Evacuation

• Are fire extinguishers available and properly labeled, inspection dates in compliance, secured and mounted properly?

  Yes

  No

  N/A

• Are exit doors clearly marked and accessible, exit lights lit and inspection dates in compliance?

  Yes

  No

  N/A

• Are emergency lights functioning properly and inspection dates in compliance?

  Yes

  No

  N/A

• Are first aid supplies fully stocked and up to date? Are AED inspection dates in compliance?

  Yes

  No

  N/A

• Are emergency evacuation plans/routes posted near exterior doors

  Yes

  No

  N/A

• Comments

Personal Protective Equipment

• Are PPE stock supplies at par levels, and inspection dates in compliance?

  Yes

  No

  N/A

• Are expired 1000V gloves prepped to be sent out for testing or currently out for testing?

  Yes

  No

  N/A

• Are eyewash stations/saline bottle stations being properly maintained and weekly inspections in compliance?

  Yes

  No

  N/A

• Comments

Hazard Communications

• Are SDS readily accessible and complete with full list of hazardous chemicals?

  Yes

  No

  N/A

• Are materials for spill clean up and employees trained?

  Yes

  No

  N/A

• Are all containers properly labeled?

  Yes

  No

  N/A

• Comments

Power Tools

• Are power tools, hand or shop powered, in good repair, properly guarded?

  Yes

  No

  N/A

• Are all corded power tools properly grounded?

  Yes

  No

  N/A

• Are all carts neat, clean and stored in an orderly manner?

  Yes

  No

  N/A

• Comments

Flammable/Combustible Materials

• Are flammable or combustible materials stored in approved cannisters?

  Yes

  No

  N/A

• Are flammable or combustible materials stored in approved storage cabinet, labeled as FLAMMABLE and securely closed?

  Yes

  No

  N/A

• Are waste containers/storage tanks properly labeled? Above ground exterior tanks protected from vehicles?

  Yes

  No

  N/A

• Is waste area properly contained if a spill were to occur?

  Yes

  No

  N/A

• Comments

Housekeeping, Walking/Working Surfaces (Warehouse)

• Are service areas, storage rooms, aisles, and other occupied areas kept clean and orderly?

  Yes

  No

  N/A

• Are trash cans and dumpsters emptied regularly and not allowed to be overfilled?

  Yes

  No

  N/A

• Is all lighting functioning properly?

  Yes

  No

  N/A

• Are all floors above ground level guarded properly?

  Yes

  No

  N/A

• Are all stairways illuminated properly and equipped with handrails in good repair?

  Yes

  No

  N/A

• Are non slip treads installed on stairways?

  Yes

  No

  N/A

• Are rest rooms cleaned and stocked?

  Yes

  No

  N/A

• Are battery powered dispensers working properly?

  Yes

  No

  N/A

• Are windows cleaned and in good repair?

  Yes

  No

  N/A

• Are corners clear of cobwebs and general dusting completed?

  Yes

  No

  N/A

• Comments

Housekeeping, Walking/Working Surfaces (Offices)

• Are walkways clear of impediment?

  Yes

  No

  N/A

• Are rugs/tile clean and in good repair?

  Yes

  No

  N/A

• Are drop ceiling tiles clean and in good repair?

  Yes

  No

  N/A

• Are extension cords being used properly, not as permanent wiring?

  Yes

  No

  N/A

• Are power strips plugged into wall outlets (not another power strip)?

  Yes

  No

  N/A

• Are trash cans and recycle bins emptied on a regular basis and not allowed to be overfilled?

  Yes

  No

  N/A

• Is all lighting functioning properly?

  Yes

  No

  N/A

• Are all stairways illuminated properly and equipped with handrails in good repair?

  Yes

  No

  N/A

• Are non slip treads installed on stairways?

  Yes

  No

  N/A

• Are rest rooms clean and stocked?

  Yes

  No

  N/A

• Are battery powered dispensers working properly?

  Yes

  No

  N/A

• Are windows cleaned and in good repair?

  Yes

  No

  N/A

• Are corners clear of cobwebs and general dusting completed?

  Yes

  No

  N/A

• Comments

Ladder Safety

• Are all ladders in good condition and inspected monthly?

  Yes

  No

  N/A

• Are all detective ladders tagged and removed from service? Are arrangements made to replace ladders?

  Yes

  No

  N/A

• Are all ladders stored securely, chained against support?

  Yes

  No

  N/A

• Comments

Electrical

• Are all electrical cords and outlets in good condition?

  Yes

  No

  N/A

• Are all electrical panels closed and secured? Junction boxes covered?

  Yes

  No

  N/A

• Are all electrical panels easily accessible, clear up to 3 feet from the front and sides of panel?

  Yes

  No

  N/A

• Are extension cords being used properly and protected from traffic or water hazards?

  Yes

  No

  N/A

• Comments

Compressed Gases

• Are tanks and cylinders properly labeled and stored/secured with chain to prevent damage?

  Yes

  No

  N/A

• Comments

Forklifts

• Are forklifts in good condition without damage?

  Yes

  No

  N/A

• Are daily inspections being performed?

  Yes

  No

  N/A

• Have all forklift operators completed Internal Combustion Class 4 & 5 training?

  Yes

  No

  N/A

• Are seat belts being worn?

  Yes

  No

  N/A

• Is 3 point contact system being used when entering/exiting the driver's compartment?

  Yes

  No

  N/A

• Are operators not leaving the forklift running while unattended?

  Yes

  No

  N/A

• Comments

Company Vehicles

• Are all service vehicles in good condition and properly maintained?

  Yes

  No

  N/A

• Are interiors maintained, safety equipment mounted or stored properly?

  Yes

  No

  N/A

• Are monthly inspections of vehicle, fire extinguishers, ladders and PPE being completed and kept in vehicle?

  Yes

  No

  N/A

• Are all trailers in good condition and properly maintained?

  Yes

  No

  N/A

• Are trailer inspection sheets being completed before trailers are towed?

  Yes

  No

  N/A

• Comments

Office Equipment/Break Rooms

• Is office and break room furniture in good repair?

  Yes

  No

  N/A

• Are break room appliances clean and working properly?

  Yes

  No

  N/A

• Comments

Landscaping/Parking Lot

• Is landscape maintenance (mowing, weeding, shrub trimming, leaf pick up, plowing/salting) being done?

  Yes

  No

  N/A

• Are any trees in need of trimming or other maintenance to prevent falling limbs or damage to property?

  Yes

  No

  N/A

• Is parking lot lighting functioning properly?

  Yes

  No

  N/A

• Are parking spaces easily visible?

  Yes

  No

  N/A

• Are curbs and parking stops in good repair?

  Yes

  No

  N/A

• Is parking lot signed properly to make navigation clear and safe?

  Yes

  No

  N/A

• Is pavement in good repair (pot holes, crack sealing)?

  Yes

  No

  N/A

• Are sidewalks clear of obstructions? Treated for ice in winter?

  Yes

  No

  N/A

• Comments

Capital/Future Requests

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Actionable Items

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• Operations Manager

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• Facilities Manager

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