• Document No.

  • Department/Floor Inspected

  • Conducted on

  • Prepared by


  • Is floors clean

  • Is floors damaged (cracked tiles, cracked concrete ect.)


  • Is walls clean

  • Is walls damaged (cracks, paint peeling ect.)


  • Is windows clean

  • Is windows damaged (cracks ect)<br>

Aisles, Walkways and Stairs

  • Not Obstructed

  • Clean


  • Handrails not damaged

  • No damaged steps

  • Well Lighted

  • Clean

Pest Control

  • Monthly Servicing

  • Is infestations/ Activity reported

HSE Sinaged

  • Is the correct HSE Signs displayed

  • Is HSE signs enough and legible

Tables and Chairs

  • Is tables and chairs clean

  • No damages


  • No Flashing

  • All working

  • No Damages to light fittings

  • No loose covers<br>


  • Building Maintenance Representitive

  • Date

  • Facilities Manager

  • Date

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.