Facility Safety Inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Exits

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

  Yes

  No

  N/A

• Are exit signs illuminated

  Yes

  No

  N/A

Fire extinguishers

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

  Yes

  No

  N/A

• Are the fire extinguishers identified?

  Yes

  No

  N/A

• Are the fire extinguishers inspected monthly?

  Yes

  No

  N/A

First aid areas

• Are first aid areas identified?

  Yes

  No

  N/A

• Is first aid area located away from break rooms?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Eyewash Stations

• is access to the eyewash station unobstructed?

  Yes

  No

  N/A

• Is the eyewash station identified?

  Yes

  No

  N/A

• is the eyewash inspected weekly?

  Yes

  No

  N/A

• Is the eyewash equipped with a tepid water supply?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Electrical

• Are cords free from hazards?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Electrical Equipment access is not prohibited.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are extension cords used for permanent positions.

  Yes

  No

  N/A

Chemicals in the facility

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

  Yes

  No

  N/A

• Are flammable chemicals grounded?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are flammable cabinets grounded?

  Yes

  No

  N/A

• Is there an eyewash station present for chemicals in use

  Yes

  No

  N/A

• Are containers provided with spill protection?

  Yes

  No

  N/A

Personal Protective equipment

• Is Personal Protective Equipment in good working order

  Yes

  No

  N/A

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?

  Yes

  No

  N/A

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