Title Page
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Site conducted
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Conducted on
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Inspected By
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Accompanied By
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Location
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Inspection Code:
Y - Meets Standard
N - Does Not Meet Standard
N/A – Not Applicable
N/R – Not Reviewed-
Emergency Evacuation & Emergency Exits
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Fire Alarm Panel
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Smoke Detectors
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Heat Sensors
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Pull Stations
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Strobes
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Fire Extinguishers
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Emergency Lights
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Exit Lights
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Carbon Monoxide Detectors (if applicable)
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Electrical Outlets
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Electrical Panels Labeled/No missing
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Breakers/Blocked
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Lighting
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Facility Exits
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Facility Exit Plan Posted
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SDS Binder Accessible/Index Current
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Chemicals Stored and Labeled Properly
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Broken Glass
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Proper Use of Extension Cords
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Trip Hazards
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Walls – Ceilings – Floors
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Doors/Door Closers/Hardware
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Laundry (Washers, Dryers, Vents, Filters)
ENVIRONMENTAL SAFETY
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Facility Cleanliness
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Trash Containers
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Urinals – Commodes
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Cleaning Supplies / Storage
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HVAC Vents
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Floor Coverings
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Outside Area – cleanliness - safe
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Check Daily Sanitizing Log
Sign Off
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Name and Signature