Information
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Site conducted
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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
Hazard Rating Matrix
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For the following questions please indicate the hazard rating where applicable:
Inspected areas & Those that were not accessed
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Identify areas that were inspected and those that were unable to gain access to during the inspection.
Either list the areas in the space below or insert close-up photos of the building key plan. -
Areas that were inspected & those which could not be accessed:
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Add media
Housekeeping
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1. Are materials and supplies stored properly on shelves, i.e. heavier material stored on lower shelves?
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
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2. Are bookcases and filing cabinets higher than 6 ft. secured to the wall?
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
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3. Are racks and shelving properly installed and in good condition?
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
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4. Are trolleys or dollies available to move heavy items?
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
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5. Are carpets, tiles or other flooring in good condition and free of tripping hazards?
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
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6. Are all aisles, stairwells, areas of refuge and doorways clear of materials and equipment?<br>• Corridors that lead to an exit must be kept clear, in good repair and a minimum width of 1.1 meters must be maintained at all times.<br>• Combustible materials are not allowed to be accumulated in any part of the exit corridors and doorways
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
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7. If space heaters are used, will they shut off when tipped over?
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
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8. Are office procedures and equipment posing potential hazards identified, and have safe work procedures been developed to mitigate the hazards?
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
General Safety
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9. Have employees received a safety orientation from their supervisor?
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
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10. Are personnel aware of hazard and reporting procedures?
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
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11. Are personnel aware of who the safety committee members are in their area?
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
Emergency Preparedness
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12. Are campus emergency numbers posted by the phone?
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
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13. Are procedures in place for personnel working alone in evenings, or weekends?
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
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14. Do personnel know how to access First Aid?
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
Fire Safety
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15. Are personnel familiar with the emergency evacuation plan, including egress routes, pull stations, extinguisher locations and assembly points?
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
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16. Do sprinkler heads have a minimum clearance of 18 inches?
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
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17. Has the fire extinguisher been inspected within the last year?
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
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18. Is the Fire extinguisher accessible?
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
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19. Are pull stations clearly visible?
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
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20. Are emergency exit signs functional (i.e., not burnt out)?
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
Hazardous Products
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21. Are hazardous products in use? If yes, identify location & types of materials.
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
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22. Do personnel working with hazardous products have WHMIS training?
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
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23. Is SDS information filed and accessible for all chemicals in use?
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
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24. Are the SDSs up-to-date or online link utilized?
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
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25. Are gloves, safety glasses and other appropriate personal protective equipment available to workers?
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
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26. Are emergency showers and eyewash stations available and unobstructed?
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
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27. Have the safety showers and eyewash stations been inspected and tested within the last year? Check the tags attached to each.
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
Electrical Safety
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28. Do all appliances have 3-pronged plugs for grounding?
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
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29. Are all wires and plugs in good condition?
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
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30. Are cables secured to prevent tripping hazards?
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
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31. Are power bars and extension cords used appropriately:<br>• It is ok to plug one power bar directly into a wall outlet or through a single extension cord into an outlet. It is not ok to plug one power bar into another power bar.<br>• Extension cords should not be plugged into power bars or into other extension cords.<br>• Extension cords should not be excessively loaded.<br>• 12 outlet power bars should not be used.
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
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32. Are all panels and covers in place on electrical equipment?
Room
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
Tools, Machinery and Equipment
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33. Are tools, machinery or equipment used? If yes, please confirm with the department that inspections of the area are being performed.
Other
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34. Are building materials in good condition?<br>• Look for any visible signs of water staining or water damage (i.e., bubbling paint, water damaged drywall, rotting wood).<br>• Ask area occupants or staff if there has been any recent water ingress reported/identified.
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Department:
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Room Number:
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Hazard Rating:
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Photo:
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Recommended Date of Completion:
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Additional Items or Comments
