Information
-
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:
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:
-
Photo:
-
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:
-
Room Number:
-
Hazard Rating:
-
Photo:
-
Recommended Date of Completion:
-
10. Are personnel aware of hazard and reporting procedures?
Room
-
Department:
-
Room Number:
-
Hazard Rating:
-
Photo:
-
Recommended Date of Completion:
-
11. Are personnel aware of who the safety committee members are in their area?
Room
-
Department:
-
Room Number:
-
Hazard Rating:
-
Photo:
-
Recommended Date of Completion:
Emergency Preparedness
-
12. Are campus emergency numbers posted by the phone?
Room
-
Department:
-
Room Number:
-
Hazard Rating:
-
Photo:
-
Recommended Date of Completion:
-
13. Are procedures in place for personnel working alone in evenings, or weekends?
Room
-
Department:
-
Room Number:
-
Hazard Rating:
-
Photo:
-
Recommended Date of Completion:
-
14. Do personnel know how to access First Aid?
Room
-
Department:
-
Room Number:
-
Hazard Rating:
-
Photo:
-
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:
-
Photo:
-
Recommended Date of Completion:
-
16. Do sprinkler heads have a minimum clearance of 18 inches?
Room
-
Department:
-
Room Number:
-
Hazard Rating:
-
Photo:
-
Recommended Date of Completion:
-
17. Has the fire extinguisher been inspected within the last year?
Room
-
Department:
-
Room Number:
-
Hazard Rating:
-
Photo:
-
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:
-
Photo:
-
Recommended Date of Completion:
-
20. Are emergency exit signs functional (i.e., not burnt out)?
Room
-
Department:
-
Room Number:
-
Hazard Rating:
-
Photo:
-
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:
-
Photo:
-
Recommended Date of Completion:
-
22. Do personnel working with hazardous products have WHMIS training?
Room
-
Department:
-
Room Number:
-
Hazard Rating:
-
Photo:
-
Recommended Date of Completion:
-
23. Is SDS information filed and accessible for all chemicals in use?
Room
-
Department:
-
Room Number:
-
Hazard Rating:
-
Photo:
-
Recommended Date of Completion:
-
24. Are the SDSs up-to-date or online link utilized?
Room
-
Department:
-
Room Number:
-
Hazard Rating:
-
Photo:
-
Recommended Date of Completion:
-
25. Are gloves, safety glasses and other appropriate personal protective equipment available to workers?
Room
-
Department:
-
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
-
Department:
-
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:
-
Photo:
-
Recommended Date of Completion:
-
32. Are all panels and covers in place on electrical equipment?
Room
-
Department:
-
Room Number:
-
Hazard Rating:
-
Photo:
-
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.
Room
-
Department:
-
Room Number:
-
Hazard Rating:
-
Photo:
-
Recommended Date of Completion:
-
Additional Items or Comments