Fire and Electrical Safety
Fire extinguishers inspected, recharged, and ready for service (check tag)
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Fire suppression inspections up to date (annual)
Current
90-Days Out
Expired
Not Applicable
Employees trained in fire extinguisher use
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Exits, stairs, dead-ends (properly marked) for egress
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Electrical and emergency equipment clear access (36" unobstructed)
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Approved surge protectors in use
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Sufficient grounded electrical outlets in work areas
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
GFCI outlets in use around sinks and wet areas
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Power strips plugged directly into wall outlets (not into other power strips or extension cords)
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Wiring and extension cord insulation in good condition
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Electrical panel doors, knock out covers, and breaker void covers in place
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Light bulb covers /guards in place
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
18" clearance maintained from ceilings and fire sprinkler stand pipes
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Flammable materials, gas bottles, and liquids stored properly
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Housekeeping and Walking Surfaces
Aisles, stairs, and floors free of boxes and clutter
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Materials stored in proper locations
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Wiring and cables organized to minimize trip hazards
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Floors, carpets, and walkways free of tripping hazards
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Area rugs and mats with non-slip rubber backing q
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Sanitary items and food properly stored
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Restrooms, break rooms, and locker areas clean
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Lights and ventilation working properly
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Areas around buildings clean
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Stairs properly maintained: treads, handrails, illumination
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Floor spills cleaned up immediately to prevent slips and falls
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Mats at building entries during rainy season
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Signs of mold or mildew
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Chemicals stored properly
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Material Handling and Ladder Safety
Safe lifting practices observed
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Stable step ladder or step stool available to access overhead items
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Ladders, stools, and carts in good condition
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Employees trained on safe ladder and push cart use
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Hand trucks and push carts available for moving heavy items
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Adequate clearance in aisles and doorways to operate material handling equipment safely
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Materials stored to prevent sprain or strain injuries
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Materials handled to prevent lifting or twisting injuries
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Repetitive lifting above shoulder level eliminated
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
File Cabinet and Storage Shelving Earthquake Safety
File cabinet drawers do not open into high traffic areas
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
File cabinet contents evenly distributed to prevent tipping
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
File drawers kept closed to prevent injuries
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Cabinets or shelving taller than 60 inches, or cabinets near points of egress secured to prevent tipping
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Heavy objects in work areas secured or stored below 60"
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
Objects stored above 60" on shelving units secured
Satisfactory
Needs Remedial Action
Needs Immediate Action
Not Applicable
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Andrew Lemen
General Fire, Life, Safety Inspection - duplicate
General safety inspection form
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You should independently determine whether the template is suitable for your circumstances.
