Adequate lighting?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
Proper guarding on lights?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
Emergency lights checked and working properly?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
Emergency evacuation route posted?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
First aid kits stocked and readily available?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
Fire extinguishers readily available?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
Fire extinguishers are properly inspected and in compliance?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
Refrigerator, coffee pot and microwave are clean?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
Housekeeping in workstations is acceptable?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
Walkways are clear of clutter?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
Proper storage of materials (overhead)?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
Proper trash containers with lids?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
All ground checks are current?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
GFCI protection on applicable outlets?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
Are all breakers, controls and switches labeled correctly?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
Are all distribution circuits properly labeled?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
Are there any missing knock-outs?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
Any spills and /or debris?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
Are all equipment / area guards in place and effective?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
Are all hand tools properly stored?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
Are all hand tools in good condition?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
Is the proper PPE readily available and being utilized?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
Is the area free of combustibles?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
All ladders / stools are in good condition and inspected?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
All doors and windows are in good condition?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
Ensure there are not any leaky sources anywhere?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
Heating and cooling works properly?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
All drains are clear?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
Is garbage management in place and effective?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
Overall building housekeeping is acceptable?
Environmental
Health (dust, noise)
Improve Safety
Positive Recognition
Housekeeping
Completion Date:
Auditor(s) Signature
Sign
Revision 1.0 iCloud posted document is the controlled copy. 07/02/13
link copied
Jeff Boothe
FMSO Mine Maintenance Planning Bldg.
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.