HSE Committee Inspection

• Conducted on

  Date

• Prepared by

• Location
  Address

• Participants

1.0 - Warehouse

• 1.1 - Administrative

  Good

  Fair

  Poor

  N/A

• 1.2 - General Safety / Housekeeping

  Good

  Fair

  Poor

  N/A

• 1.3 - Fire Protection

  Good

  Fair

  Poor

  N/A

• 1.4 - Electrical

  Good

  Fair

  Poor

  N/A

• 1.5 - Computer Workstations

  Good

  Fair

  Poor

  N/A

• 1.6 - Any unsafe condition

  Yes

  No

  N/A

2.0 - Production

• 2.1 - Administrative

  Good

  Fair

  Poor

  N/A

• 2.2 - General Safety/ Housekeeping

  Good

  Fair

  Poor

  N/A

• 2.3 - Fire Protection

  Good

  Fair

  Poor

  N/A

• 2.4 - Electrical

  Good

  Fair

  Poor

  N/A

• 2.5 - Computer Workstation

  Good

  Fair

  Poor

  N/A

• 2.6 - Any unsafe condition

  Yes

  No

  N/A

Sign Off

• Report prepared by

  Sign