Facility Safety and Sanitation Inspection

• Document No.

• Audit Title

• Conducted on

  Date

• Client / Site

• Prepared by

• Location
  Address

• Personnel

Fire Safety

Posters

• Emergency Evacuation Plan Posted?

  Yes

  No

  N/A

• RIGHT TO KNOW POSTER PRESENT?

  Yes

  No

  N/A

• PEOSH POSTER PRESENT?

  Yes

  No

  N/A

OSHA 300 LOG

• Current OSHA 300A annual summary present?

  Yes

  No

  N/A

• Current Monthly Summary Present in File?

  Yes

  No

  N/A

• OSHA 300 LOG FILE MAINTAINED?

  Yes

  No

  N/A

HVAC System

• Heating ventilation and air condition maintenance records kept for the past three years?

  Yes

  No

  N/A

• HVAC system visually clean with no dust accumulations?

  Yes

  No

  N/A

Right to Know

• Hazardous Substance Fact Sheets Available?

  Yes

  No

  N/A

• Safety Data Sheets Available?

  Yes

  No

  N/A

• Current Right to Know Survey Present?

  Yes

  No

  N/A

• Right to Know Central File Present?

  Yes

  No

  N/A

Hazard Communication

• Written Hazard Communication Plan Available?

  Yes

  No

  N/A

• Is the PPE hazard assessment table inclusive of all substances being used?

  Yes

  No

  N/A

• Have all employees been trained within the last 2 years?

  Yes

  No

  N/A

• Janitorial frequency appropriate to maintain facility in a sanitary condition?

  Yes

  No

  N/A

• Does the facility manager know who the water company is?

  Yes

  No

  N/A

• Are there water test results available?

  Yes

  No

  N/A

Safety and Security

• Are there security panic button installed?

  Yes

  No

  N/A

• Adequate police response to the facility?

  Yes

  No

  N/A

• On site police or security present?

  Yes

  No

  N/A

Fire Alarm System

• Fire alarm annual inspection current?

  Yes

  No

  N/A

• Is the fire alarm system normal?

  Yes

  No

  N/A

• Is the fire alarm system powered?

  Yes

  No

  N/A

Sprinkler System

• No storage within 18 inches of sprinkler head?

  Yes

  No

  N/A

• No storage within 24 inches of the the ceiling?

  Yes

  No

  N/A

• Sprinkler system annual inspection current?

  Yes

  No

  N/A

Doors and Means of Egress

• Means of egress free from obstruction?

  Yes

  No

  N/A

• Exit discharge clear?

  Yes

  No

  N/A

• Locks operate without special knowledge?

  Yes

  No

  N/A

• Fire doors unchocked?

  Yes

  No

  N/A

• Fire doors open and latch properly?

  Yes

  No

  N/A

Emergency Exit Signs and Lights

• Exit Signs are illuminated?

  Yes

  No

  N/A

• Exit Signs are not obstructed from view?

  Yes

  No

  N/A

• Battery back up power working properly?

  Yes

  No

  N/A

• Evacuation battery backup lights working properly?

  Yes

  No

  N/A

• Exit sign and light monthly check log maintained?

  Yes

  No

  N/A

Emergency Generator

• Annual test documentation available?

  Yes

  No

  N/A

Fire Extinguishers

• Properly mounted?

  Yes

  No

  N/A

• Monthly inspection tag signed and dated?

  Yes

  No

  N/A

• Unobstructed access?

  Yes

  No

  N/A

• Annual inspection current?

  Yes

  No

  N/A

Emergency Eye Wash Stations

• Station available?

  Yes

  No

  N/A

• Identification sign clearly visible?

  Yes

  No

  N/A

• Unobstructed access?

  Yes

  No

  N/A

• 6-month maintenance record available?

  Yes

  No

  N/A

Mechanical/Telephone/CPU Room

• Door labeled and working properly?

  Yes

  No

  N/A

• Fire extinguisher located within 75 feet?

  Yes

  No

  N/A

• Fire extinguisher compliant?

  Yes

  No

  N/A

• No storage or obstruction present?

  Yes

  No

  N/A

• Clean?

  Yes

  No

  N/A

• Adequately illuminated?

  Yes

  No

  N/A

• Electrical panels and circuits labeled/identified?

  Yes

  No

  N/A

• No defective or unused electrical equipment present?

  Yes

  No

  N/A

• No defective or unused mechanical equipment present?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Storage Room

• Orderly appearance?

  Yes

  No

  N/A

• Fire extinguisher located within 75 feet?

  Yes

  No

  N/A

• Aisles are unobstructed and clearly marked?

  Yes

  No

  N/A

• Storage is secured against collapse?

  Yes

  No

  N/A

• Racks are bolted to the wall?

  Yes

  No

  N/A

• No storage within 24 inches of the ceiling?

  Yes

  No

  N/A

• No defective or unused equipment?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Building Exterior/Grounds

• Exits are clear?

  Yes

  No

  N/A

• Exit discharge from building to assembly areas are clear?

  Yes

  No

  N/A

• No tripping hazards present?

  Yes

  No

  N/A

• Adequate vegetation control?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Sanitation

Rest Room (Mens)

• Orderly appearance?

  Yes

  No

  N/A

• Fixtures clean?

  Yes

  No

  N/A

• Hot, cold, or tepid water available?

  Yes

  No

  N/A

• Hand soap or sanitizer available for cleansing?

  Yes

  No

  N/A

• Hand towels or air blower available?

  Yes

  No

  N/A

• Partitions in good repair?

  Yes

  No

  N/A

• Floor in good condition with no leaks?

  Yes

  No

  N/A

• Outlets protected by GFCI?

  Yes

  No

  N/A

• GFCI outlets working?

  Yes

  No

  N/A

• Adequate ventilation?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Adequate lighting?

  Yes

  No

  N/A

Rest Room (Ladies)

• Orderly appearance?

  Yes

  No

  N/A

• Fixtures clean?

  Yes

  No

  N/A

• Hot, cold, or tepid water available?

  Yes

  No

  N/A

• Hand soap or sanitizer available for cleansing?

  Yes

  No

  N/A

• Hand towels or air blower available?

  Yes

  No

  N/A

• Partitions in good repair?

  Yes

  No

  N/A

• Floor in good condition with no leaks?

  Yes

  No

  N/A

• Outlets protected by GFCI?

  Yes

  No

  N/A

• GFCI outlets working?

  Yes

  No

  N/A

• Adequate ventilation?

  Yes

  No

  N/A

• Air vents clean?

  Yes

  No

  N/A

• Adequate lighting?

  Yes

  No

  N/A

Employee Work Area

• Under counter areas clean?

  Yes

  No

  N/A

• Work area free of visible insects or evidence of pests?

  Yes

  No

  N/A

• Limited or no plants present?

  Yes

  No

  N/A

• Food stuffs stored appropriately?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Break/Lunch Room

• Orderly and clean in appearance?

  Yes

  No

  N/A

• Free of visible insects or evidence of pests?

  Yes

  No

  N/A

• Garbage cans have lids?

  Yes

  No

  N/A

• Furniture in good repair?

  Yes

  No

  N/A

• Food stuffs stored appropriately?

  Yes

  No

  N/A

• Pest control records available?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Customer Wait Area

• Orderly and clean in appearance?

  Yes

  No

  N/A

• Furniture in good repair?

  Yes

  No

  N/A

• Water fountain clean?

  Yes

  No

  N/A

First Aid Supplies

• Identification sign present?

  Yes

  No

  N/A

• AED Functional?

  Yes

  No

  N/A

• Adequate supplies available?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

• Signature

  Sign