• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel


  • Are exits free from any obstruction within 5 feet inside and out?

  • Are exit signs illuminated

Fire extinguishers

  • Is there 3 three feet of clearance around all fire extinguishers

  • Are the fire extinguishers identified?

  • Are the fire extinguishers inspected monthly?

First aid areas

  • Are first aid areas identified?

  • Is first aid area located away from break rooms?

  • Is the first aid area stocked with the required fill?

Eyewash Stations

  • is access to the eyewash station unobstructed?

  • Is the eyewash station identified?

  • is the eyewash inspected weekly?

  • Is the eyewash equipped with a tepid water supply?

  • If the eyewash is plumbed is the water solution changed out at regular 160 day intervals?


  • Are cords free from hazards?

  • Only single extension cords are being used at a time to a piece of equipment.

  • There are no cords tied around pipes, table legs etc

  • All electrical boxes have their covers securely fastened in place.

  • All electrical boxes are identified with their voltage, phase and what they are controlling.

  • Electrical Equipment access is not prohibited.

  • Is the electrical equipment suitable for its location? Ex.. Wet area

  • Are lights used for illumination covered with a guard or coated bulb?

  • Are extension cords used for permanent positions.

Chemicals in the facility

  • Are containers in the facility identified with their chemical contents?

  • Are flammable chemicals grounded?

  • Are flammable chemicals stored 20' away from an exit?

  • Are flammable cabinets grounded?

  • Is there an eyewash station present for chemicals in use

  • Are containers provided with spill protection?

Personal Protective equipment

  • Is Personal Protective Equipment in good working order

Other Information

  • Are there other issues occurring not mentioned in the issues above

  • Problem
  • Are there other issues not identified in any of the preceding areas?

  • Enter details

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.