Title Page
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Company/ Worksite
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Inspected by
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Date and Time
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Location
Safety Mentions
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Click "add" and list good safety precautions and compliant procedures
Item
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Safety Observation
- Accessibility
- Work Environment
- Tidiness
- Cleanliness
- Lighting
- Fire Safety Equipment & Procedures
- Electrical hazards
- Personal Protective Equipment (PPE)
- Storage/Containment
- Other
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Are Safe Work Practices being Followed?
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Are their hazards that need to be mitigated?
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If Yes, what steps where taken?
Opportunities for Improvement
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Click "add" and list items that need to be looked into or changed
Item
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Opportunities for improvement category
- Accessibility
- Work Environment
- Tidiness
- Cleanliness
- Lighting
- Fire Safety Equipment & Procedures
- Electrical hazards
- Personal Protective Equipment (PPE)
- Storage/Containment
- Other
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Identify category the item belongs to
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Enter description
Critical Items
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Click "add" and identify items in need of urgent action
Item
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Critical item category
- Accessibility
- Work Environment
- Tidiness
- Cleanliness
- Lighting
- Fire Safety Equipment & Procedures
- Electrical hazards
- Personal Protective Equipment (PPE)
- Storage/Containment
- Other
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Identify category the item belongs to
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Enter description
Completion
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Additional recommendation
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Inspector's Full Name & Signature
