Health, Safety & Security--Questions From Fulcrum

• Type of Inpection

• Conducted on

  Date

• Prepared by

• Location
  Address

• NOTE:
  Adhere to the following rules while inputting data.
  1. All data must be accurate and complete.
  2. All photos must be in landscape orientation, clear and focused, and provide either detailed or general view as required.
  3. Included a titled, dated, signed sketch of the plot.
  4. Add additional commentary when the dropdown menu is insufficient to capture all details.
  Rating System:
  1. Excellent 2. Good 3.Poor

Incident Details

• Is there Clearly Marked Safety/Site ID<br>Signage Onsite

  Yes

  No

  N/A

• Is the Site Security Lightings in good state?

  Yes

  No

  N/A

• Yes

  No

  N/A

• Please describe any damage (bulb not working, cable disconnected, etc)

• Is the Site Gate Locks still Active?

  Yes

  No

  N/A

• Is the CCTV still in good condition?

  Yes

  No

  N/A

• Site CCTV Conditions:

• No. of CCTV Cameras

• Site CCTV Photos

  Media

• Is the Fire Extinguisher in good Condition and Available?

  Yes

  No

  N/A

• Is the Aviation Lights in Good Condition?

  Yes

  No

  N/A

• Take photo of surrounding environment including any annotations

  Media

Sign Off

• Signed off by supervisor when corrective actions have been adopted and monitored

• Management comments

• Supervisor sign off

  Sign