Title Page
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Client / Site
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Conducted on (Date and Time)
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Inspected by
Housekeeping Questions
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Are break areas cleaned on a regular basis, including microwaves and refrigerators?
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What is the issue?
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Where was the issue found?
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Are floors and WWS clean and clear of waste, unnecessary water, and grease?
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What is the issue?
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Where was the issue found?
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Are work areas clear of personal items, such as clothing and lunch boxes?
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What is the issue?
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Is the work area organized and free of unnecessary materials?
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What is the issue?
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Where was the issue found?
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Are employees given adequate time to clean at some point during their shift?
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Why are they not given adequate time?
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Who is their supervisor?
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What is the supervisor's response?
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Are stairs and exits (includes exit access, the exit, and exit discharge) unobstructed and free of material/debris?
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What is the issue?
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Where was the issue found?
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Is the workplace lighting adequate?
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What is issue?
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Where was the issue found?
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Are stairs well lit and in good condition?
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What is the issue?
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Where was the issue found?
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Are exits marked and adequately lit?
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What is the issue?
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Where was the issue found?
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Are absorbents and spill kits readily available?
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Where was the issue found?
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Are absorbents and spill kits used as necessary?
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What is the issue?
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Where was the issue found?
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Are there adequate number of waste containers?
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Where was the issue found?
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Are waste containers emptied regularly?
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Where was the issue found?
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Are all tools, machines, and equipment cleaned up after finishing a job or before leaving the job site?
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What is the issue?
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Where was the issue found?
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Are cords, hoses, and chains wrapped up and off the ground when not being actively used?
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What is the issue?
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Where was the issue found?
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Are tools properly stored in their designated places?
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What is the issue?
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Where was the issue found?
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Are all materials stored safely i.e. stair-step stacked, secured, organized, etc.?
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What is the issue?
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Where was the issue found?
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Are materials stored in areas that do not obstruct or hinder access to electrical panels?
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What is the issue?
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Where was the issue found?
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Are emergency equipment (fire extinguishers, eyewash stations, and AEDs) accessible and with no material or objects placed within 36" of the front them?
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What is the issue?
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Where was the issue found?
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Are combustible, flammable, and hazardous materials stored properly?
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What is the issue?
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Where was the issue found?
Completion
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Full Name and Signature of the Inspector
