Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Posters
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Emergency Evacuation Plan Posted?
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RIGHT TO KNOW POSTER PRESENT?
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PEOSH POSTER PRESENT?
OSHA 300 LOG
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Current OSHA 300A annual summary present?
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Current Monthly Summary Present in File?
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OSHA 300 LOG FILE MAINTAINED?
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Heating ventilation and air condition maintenance records kept for the past three years?
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HVAC system visually clean with no dust accumulations?
Right to Know
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Hazardous Substance Fact Sheets Available?
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Safety Data Sheets Available?
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Current Right to Know Survey Present?
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Right to Know Central File Present?
Hazard Communication
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Written Hazard Communication Plan Available?
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Is the PPE hazard assessment table inclusive of all substances being used?
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Have all employees been trained within the last 2 years?
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Janitorial frequency appropriate to maintain facility in a sanitary condition?
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Does the facility manager know who the water company is?
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Are there water test results available?
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Are there security panic button installed?
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Adequate police response to the facility?
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On site police or security present?
Fire Alarm System
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Fire alarm annual inspection current?
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Is the fire alarm system normal?
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Is the fire alarm system powered?
Sprinkler System
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No storage within 18 inches of sprinkler head?
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No storage within 24 inches of the the ceiling?
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Sprinkler system annual inspection current?
Doors and Means of Egress
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Means of egress free from obstruction?
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Exit discharge clear?
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Locks operate without special knowledge?
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Fire doors unchocked?
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Fire doors open and latch properly?
Emergency Exit Signs and Lights
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Exit Signs are illuminated?
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Exit Signs are not obstructed from view?
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Battery back up power working properly?
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Evacuation battery backup lights working properly?
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Exit sign and light monthly check log maintained?
Emergency Generator
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Annual test documentation available?
Fire Extinguishers
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Properly mounted?
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Monthly inspection tag signed and dated?
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Unobstructed access?
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Annual inspection current?
Emergency Eye Wash Stations
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Station available?
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Identification sign clearly visible?
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Unobstructed access?
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6-month maintenance record available?
Rest Room (Mens)
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Orderly appearance?
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Fixtures clean?
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Partitions in good repair?
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Floor in good condition with no leaks?
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Hot, cold, or tepid water available?
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Outlets protected by GFCI?
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GFCI outlets working?
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Adequate ventilation?
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Adequate lighting?
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Air vents clean?
Rest Room (Ladies)
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Orderly appearance?
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Fixtures clean?
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Partitions in good repair?
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Floor in good condition with no leaks?
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Hot, cold, or tepid water available?
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Outlets protected by GFCI?
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GFCI outlets working?
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Adequate ventilation?
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Adequate lighting?
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Air vents clean?
First Aid Supplies
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Identification sign present?
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AED Functional?
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Adequate supplies available?
Sanitation
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Employee areas clean?
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Under counter areas clean?
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Customer areas clean?
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Work areas free of visible insects?
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Limited or no plants present?
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Food stuffs stored appropriately?
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Break room garbage cans have lids?
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Pest control records available?
Break/Lunch Room
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Orderly appearance?
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Clean?
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Furniture in good repair?
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Water fountain clean?
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No storage within 24 inches of ceiling?
Mechanical/Telephone/CPU Room
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Door labeled and working properly?
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Fire extinguisher located within 75 feet?
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Fire extinguisher compliant?
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No storage or obstruction present?
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Clean?
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Adequately illuminated?
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Electrical panels and circuits labeled/identified?
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No defective or unused electrical equipment present?
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No defective or unused mechanical equipment present?
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Other?
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Other?
Storage Room
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Orderly appearance?
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Fire extinguisher located within 75 feet?
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Aisles are unobstructed and clearly marked?
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Storage is secured against collapse?
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Racks are bolted to the wall?
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No storage within 24 inches of the ceiling?
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No defective or unused equipment?
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Other?
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Other?
Building Exterior/Grounds
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Exits are clear?
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Exit discharge from building to assembly areas are clear?
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No tripping hazards present?
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Adequate vegetation control?
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Other?
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Other?
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Signature