Information
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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
Arctic corridor
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Housekeeping complete?
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Exit sign illuminated?
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Doors free of obstruction?
Stair Cases
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Free of obstructions
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Emergency evacuation maps posted?
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No smoking signs posted?
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Exit sign illuminated?
First Floor Hallway
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Exit sign illuminated?
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Fire extinguisher present and ready?
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<br>Emergency lighting working?
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Water cooler area clean and free of obstructions?
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Water cooler electrical cord quaterly inspection tag upto date?
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Midway exit clear and clean with signage ?
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Storage room clean with dirty and clean laundry separated ?
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Emergency exit doors kept closed ?
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Doors to rooms closed ?
First Floor Laundry Room
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Door closed ?
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Sharps container present?
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Housekeeping complete ?
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MSDS binder present and upto date?
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Lint removed from dryers?
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Chemicals stored properly?
First Floor Housekeeping
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Spray bottles properly labeled ?
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Vacuum cleaner electrical cord inspected (i.e updated inspection tags)?
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Room clean and orderly?
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MSDS binder present and upto date?
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Cart in good working order?
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PPE available? (gloves, masks' and glasses)
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No personal luggage ?
First Floor Mechanical/Electrical Room
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Fire extinguisher ready and available for use?
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Room free and clear of debris?
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Taps in off position with no signs of leaks?
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Nothing to the right of the hatched black/yellow tape?
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Chemicals stored on floor to the sink?
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Mops hanging on proper hangers?
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Eye wash stations mounted and visible?
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Carts stored properly with no linens in it?
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Carbon monoxide detector green and not beeping?
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Water tank clear and clean?
Second Floor Hallway
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Exit sign illuminated?
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Fire extinguisher present and ready?
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Water cooler area clean and free of obstructions?
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Midway exit clear and clean with signage ?
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Storage room clean with dirty and clean laundry separated ?
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Doors to rooms closed ?
Second Floor Laundry Room
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Door closed ?
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Sharps container available?<br>
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Housekeeping complete ?
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MSDS binder present and upto date?
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Lint removed from dryers?
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Chemicals stored properly?
Second Floor Housekeeping Room
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Spray bottles properly labeled ?
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Vacuum cleaner electrical cord inspected (i.e updated inspection tags)?
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Room clean and orderly?
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MSDS binder upto date?
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Cart in good working order?
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PPE available? (gloves, masks and glasses)
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No personal luggage ?
Second Floor Mechanical/Electrical Room
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Fire extinguisher ready and available for use?
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Room free and clear of debris?
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Taps in off position with no signs of leaks.
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Nothing to the right of the hatched black/yellow tape?
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Taps in off position with no signs of leaks.
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Chemicals stored on floor to the sink?
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Mops hanging on proper hangers?
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Eye wash stations mounted and visible?
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Carts stored properly with no linens in it?
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Carbon monoxide detector green and not beeping?
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Water tanks clear and clean?
Observations
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Comments/Observations/Hazards
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Was an FLRA audit completed for this dorm?
Corrective Actions Required
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Action Owner Due Date
Inspection Review
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HSE review
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Management Review
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Front Line Supervisor
