Information

  • Site conducted

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Hazard Rating Matrix

  • For the following questions please indicate the hazard rating where applicable:

    hazard matrix.jpg

Inspected areas & Those that were not accessed

  • 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:

  • Add media

Housekeeping

  • 1. Are materials and supplies stored properly on shelves, i.e. heavier material stored on lower shelves?

  • Room
  • Department:

  • Room Number:

  • Hazard Rating:

  • Photo:

  • Recommended Date of Completion:

  • 2. Are bookcases and filing cabinets higher than 6 ft. secured to the wall?

  • Room
  • Department:

  • Room Number:

  • Hazard Rating:

  • Photo:

  • Recommended Date of Completion:

  • 3. Are racks and shelving properly installed and in good condition?

  • Room
  • Department:

  • Room Number:

  • Hazard Rating:

  • Photo:

  • Recommended Date of Completion:

  • 4. Are trolleys or dollies available to move heavy items?

  • Room
  • Department:

  • Room Number:

  • Hazard Rating:

  • Photo:

  • Recommended Date of Completion:

  • 5. Are carpets, tiles or other flooring in good condition and free of tripping hazards?

  • Room
  • Department:

  • Room Number:

  • Hazard Rating:

  • Photo:

  • Recommended Date of Completion:

  • 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
  • Department:

  • Room Number:

  • Hazard Rating:

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  • Recommended Date of Completion:

  • 7. If space heaters are used, will they shut off when tipped over?

  • Room
  • Department:

  • Room Number:

  • Hazard Rating:

  • Photo:

  • Recommended Date of Completion:

  • 8. Are office procedures and equipment posing potential hazards identified, and have safe work procedures been developed to mitigate the hazards?

  • Room
  • Department:

  • Room Number:

  • Hazard Rating:

  • Photo:

  • Recommended Date of Completion:

General Safety

  • 9. Have employees received a safety orientation from their supervisor?

  • Room
  • Department:

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  • Hazard Rating:

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  • Recommended Date of Completion:

  • 10. Are personnel aware of hazard and reporting procedures?

  • Room
  • Department:

  • Room Number:

  • Hazard Rating:

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  • Recommended Date of Completion:

  • 11. Are personnel aware of who the safety committee members are in their area?

  • Room
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  • Room Number:

  • Hazard Rating:

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  • Recommended Date of Completion:

Emergency Preparedness

  • 12. Are campus emergency numbers posted by the phone?

  • Room
  • Department:

  • Room Number:

  • Hazard Rating:

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  • Recommended Date of Completion:

  • 13. Are procedures in place for personnel working alone in evenings, or weekends?

  • Room
  • Department:

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  • Hazard Rating:

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  • Recommended Date of Completion:

  • 14. Do personnel know how to access First Aid?

  • Room
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  • Room Number:

  • Hazard Rating:

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  • Recommended Date of Completion:

Fire Safety

  • 15. Are personnel familiar with the emergency evacuation plan, including egress routes, pull stations, extinguisher locations and assembly points?

  • Room
  • Department:

  • Room Number:

  • Hazard Rating:

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  • Recommended Date of Completion:

  • 16. Do sprinkler heads have a minimum clearance of 18 inches?

  • Room
  • Department:

  • Room Number:

  • Hazard Rating:

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  • Recommended Date of Completion:

  • 17. Has the fire extinguisher been inspected within the last year?

  • Room
  • Department:

  • Room Number:

  • Hazard Rating:

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  • Recommended Date of Completion:

  • 18. Is the Fire extinguisher accessible?

  • Room
  • Department:

  • Room Number:

  • Hazard Rating:

  • Photo:

  • Recommended Date of Completion:

  • 19. Are pull stations clearly visible?

  • Room
  • Department:

  • Room Number:

  • Hazard Rating:

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  • Recommended Date of Completion:

  • 20. Are emergency exit signs functional (i.e., not burnt out)?

  • Room
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  • Room Number:

  • Hazard Rating:

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  • Recommended Date of Completion:

Hazardous Products

  • 21. Are hazardous products in use? If yes, identify location & types of materials.

  • Room
  • Department:

  • Room Number:

  • Hazard Rating:

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  • Recommended Date of Completion:

  • 22. Do personnel working with hazardous products have WHMIS training?

  • Room
  • Department:

  • Room Number:

  • Hazard Rating:

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  • Recommended Date of Completion:

  • 23. Is SDS information filed and accessible for all chemicals in use?

  • Room
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  • Recommended Date of Completion:

  • 24. Are the SDSs up-to-date or online link utilized?

  • Room
  • Department:

  • Room Number:

  • Hazard Rating:

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  • Recommended Date of Completion:

  • 25. Are gloves, safety glasses and other appropriate personal protective equipment available to workers?

  • Room
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  • Room Number:

  • Hazard Rating:

  • Photo:

  • Recommended Date of Completion:

  • 26. Are emergency showers and eyewash stations available and unobstructed?

  • Room
  • Department:

  • Room Number:

  • Hazard Rating:

  • Photo:

  • Recommended Date of Completion:

  • 27. Have the safety showers and eyewash stations been inspected and tested within the last year? Check the tags attached to each.

  • Room
  • Department:

  • Room Number:

  • Hazard Rating:

  • Photo:

  • Recommended Date of Completion:

Electrical Safety

  • 28. Do all appliances have 3-pronged plugs for grounding?

  • Room
  • Department:

  • Room Number:

  • Hazard Rating:

  • Photo:

  • Recommended Date of Completion:

  • 29. Are all wires and plugs in good condition?

  • Room
  • Department:

  • Room Number:

  • Hazard Rating:

  • Photo:

  • Recommended Date of Completion:

  • 30. Are cables secured to prevent tripping hazards?

  • Room
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  • Room Number:

  • Hazard Rating:

  • Photo:

  • Recommended Date of Completion:

  • 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
  • Department:

  • Room Number:

  • Hazard Rating:

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  • Recommended Date of Completion:

  • 32. Are all panels and covers in place on electrical equipment?

  • Room
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  • Room Number:

  • Hazard Rating:

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  • Recommended Date of Completion:

Tools, Machinery and Equipment

  • 33. Are tools, machinery or equipment used? If yes, please confirm with the department that inspections of the area are being performed.

Other

  • 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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  • Recommended Date of Completion:

  • Additional Items or Comments

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.