Form [Sample template]

• Welcome to the inspection experience on SafetyCulture!
  
  Everything you see in this sample inspection experience can be customized using the Template Editor.
  
  This page is the title page, which is the first page you see when you conduct a new inspection or view an inspection report.
  
  Title pages are a great way to capture essential details, giving you high-level context to inspection results.

• Form ID

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

Previous inspection

• Has the last inspection been reviewed?

  Yes

  No

  N/A

• Are there no outstanding actions?

  Yes

  No

  N/A

Fire prevention

• Evacuation plan displayed and understood by all employees?

  Yes

  No

  N/A

• Evacuation procedures discussed regularly? (3 to 4 times a year)

  Yes

  No

  N/A

• Extinguishers in place, clearly marked for type of fire?

  Yes

  No

  N/A

• Extinguishers recently serviced? (Check 6 monthly punch mark on tabs.)

  Yes

  No

  N/A

• Adequate direction notices for fire exits?

  Yes

  No

  N/A

• Exit doors easily opened from inside?

  Yes

  No

  N/A

• Exits clear of obstructions?

  Yes

  No

  N/A

• Fire alarm system functioning correctly?

  Yes

  No

  N/A

First aid facilities

• Are contents regularly checked?

  Yes

  No

  N/A

• No contents past their expiry date?

  Yes

  No

  N/A

• Cabinets clearly labelled?

  Yes

  No

  N/A

• Is there easy access to cabinets?

  Yes

  No

  N/A

• Employees aware of location of first aid cabinet?

  Yes

  No

  N/A

• Are first aid officers accessible?

  Yes

  No

  N/A

• Are emergency numbers displayed?

  Yes

  No

  N/A

Office hazards

• Condition of filing cabinets?

  Yes

  No

  N/A

• Condition of chairs? (Five star bases.)

  Yes

  No

  N/A

• Desks in good condition? (No damage.)

  Yes

  No

  N/A

• Screen based equipment positioned to reduce glare from windows etc?

  Yes

  No

  N/A

• Photocopiers positioned to avoid fumes?

  Yes

  No

  N/A

• Tasks designed to prevent Occupational Overuse Syndrome? (Breaks included.)

  Yes

  No

  N/A

• Air conditioning systems regularly maintained?

  Yes

  No

  N/A

• Stable non-slip floor coverings in good condition?

  Yes

  No

  N/A

Sign off

• On site representative

  Sign

• Auditor's signature

  Sign

• Yes

  No

  N/A