Title Page

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Fire and Electrical Safety

  • Fire extinguishers inspected, recharged, and ready for service (check tag)

  • Fire suppression inspections up to date (annual)

  • Employees trained in fire extinguisher use

  • Exits, stairs, dead-ends (properly marked) for egress

  • Electrical and emergency equipment clear access (36" unobstructed)

  • Approved surge protectors in use

  • Sufficient grounded electrical outlets in work areas

  • GFCI outlets in use around sinks and wet areas

  • Power strips plugged directly into wall outlets (not into other power strips or extension cords)

  • Wiring and extension cord insulation in good condition

  • Electrical panel doors, knock out covers, and breaker void covers in place

  • Light bulb covers /guards in place

  • 18" clearance maintained from ceilings and fire sprinkler stand pipes

  • Flammable materials, gas bottles, and liquids stored properly

Housekeeping and Walking Surfaces

  • Aisles, stairs, and floors free of boxes and clutter

  • Materials stored in proper locations

  • Wiring and cables organized to minimize trip hazards

  • Floors, carpets, and walkways free of tripping hazards

  • Area rugs and mats with non-slip rubber backing q

  • Sanitary items and food properly stored

  • Restrooms, break rooms, and locker areas clean

  • Lights and ventilation working properly

  • Areas around buildings clean

  • Stairs properly maintained: treads, handrails, illumination

  • Floor spills cleaned up immediately to prevent slips and falls

  • Mats at building entries during rainy season

  • Signs of mold or mildew

  • Chemicals stored properly

Material Handling and Ladder Safety

  • Safe lifting practices observed

  • Stable step ladder or step stool available to access overhead items

  • Ladders, stools, and carts in good condition

  • Employees trained on safe ladder and push cart use

  • Hand trucks and push carts available for moving heavy items

  • Adequate clearance in aisles and doorways to operate material handling equipment safely

  • Materials stored to prevent sprain or strain injuries

  • Materials handled to prevent lifting or twisting injuries

  • Repetitive lifting above shoulder level eliminated

File Cabinet and Storage Shelving Earthquake Safety

  • File cabinet drawers do not open into high traffic areas

  • File cabinet contents evenly distributed to prevent tipping

  • File drawers kept closed to prevent injuries

  • Cabinets or shelving taller than 60 inches, or cabinets near points of egress secured to prevent tipping

  • Heavy objects in work areas secured or stored below 60"

  • Objects stored above 60" on shelving units secured

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.