Title Page
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Client / Site
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Conducted on
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Prepared by Robyn Edwards
ELECTRICAL SAFETY
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Electrical control panels clearly identified and secured?
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Electrical control panel(s) requiring action:
Hazard
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Damaged/exposed electrical wiring?
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Damaged/exposed electrical wiring requiring action:
Hazard
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Switch and cover plates in place?
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Switch and/or cover plates requiring action:
Hazard
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Flexible extension cords fray-free, absent of splices, and only used as temporary power supply?
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Flexible extension cord hazard(s) requiring action:
Hazard
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Electrical knock-outs in place?
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Missing knock-outs requiring action:
Hazard
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FLOORS & STAIRS
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Areas free of slip, trip, and/or fall hazards?
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Slip, trip, and/or fall hazard(s) requiring action:
Hazard
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Apertures or openings enclosed or covered?
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Apertures and/or opening(s) requiring action:
Hazard
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Clean, orderly, and free of oil/grease?
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Housekeeping and/or oil/grease hazards requiring action:
Hazard
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Sturdy railings on all open sides?
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Railing(s) requiring action:
Hazard
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Stairs free of damage?
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Stair(s) requiring action:
Hazard
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MACHINE GUARDING
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Guards secure and in place at each point of operation?
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Guard(s) requiring action:
Hazard
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FIRE PREVENTION/PROTECTION
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Fire extinguishers checked, readily accessible, and inspected monthly?
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Fire extinguisher(s) requiring action:
Hazard
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Flammable materials (i.e., gasoline, diesel, etc.) stored in metal safety cans?
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Flammable materials requiring action:
Hazard
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HAZARDOUS CHEMICALS
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Labels on all supplier drums and/or chemicals?
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Supplier drums and/or chemicals requiring action:
Hazard
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OTHER
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Other hazards/non-compliance items found?
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Other hazard/non-compliance item(s) found requiring action:
Hazard
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Unsafe practices observed?
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Unsafe practices observed requiring action:
Unsafe Practice
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By signing below, I acknowledge the inspection/audit findings and corrective actions have been reviewed with me.