Title Page

Client Details Pre Visit

  • Client name & ID

  • Conducted on

  • Policy start date

  • Total # of claims to date

  • Total # of open claims

  • Total # of employees

  • WC Codes currently in use


  • FEIN

  • States operating in

  • Prepared by

  • Inspection conducted by

  • Location

Confirmation Questions

  • Does the total number of employees seem accurate?

  • Do the current worker’s comp codes seem accurate?

  • Are the states the client operates in accurate?

  • Does the NAICS seem accurate?

  • Areas of concern the business contact has surrounding safety/WC that they want inspected for sure before the end of the visit.

Entry to On-Site

Site Visit Questions

  • Company representative who was present during inspection?

  • Do you currently have an existing and updated IIPP?

  • Would the client be interested in additional help in this area?

  • Do you currently have an existing and updated Emergency Action Plan?

  • Would the client be interested in additional help in this area?

  • Do you currently have a Safety Committee?

  • How frequently do they meet?

  • Would you like more information on this?

  • Do you currently have an updates SDS Binder?

  • Would you like some assistance in setting one up?

  • Has client been sited by OSHA in the last year?

  • Do you have a return to work program in place?

  • Are all proper OSHA & labor laws posted and completed

  • Is there an Accident / Incident Investigation reporting form and policy in place?

Innoworks Support Questions

  • Do you currently utilize the Innoworks-provided AFLAC plan to reduce false Worker’s Comp claims (free of charge)

  • Would you like more information on this plan and how it can help reduce costs?

  • Would you like more information on other Innoworks-provided services, such as medical insurance benefits and 401(K)?

  • What would you like more information about?

Hazard Identification

  • Are workers trained to identify workplace hazards?

  • Is there a system in place for reporting hazards promptly?

Emergency Procedures

  • Are emergency exits clearly marked and unobstructed?

  • Are workers aware of evacuation routes and assembly points?

  • Are emergency drills conducted regularly?

  • Surveillance cameras in good working condition free of any obstructions?

Machinery and Equipment Safety

  • Are safe operating procedures in place and followed?

  • Are machines properly guarded and maintained?

  • Is there a lockout/tagout program in place?

Injury Reporting and First Aid

  • Are workers aware of the procedure for reporting injuries or incidents?

  • Is there a designated person responsible for first aid?

  • Are first aid kits readily available and properly stocked?


  • Is personal protective equipment (PPE) provided as needed (coveralls, gloves, eye protection, respirators, earplugs, etc)?

  • Are employees wearing PPE correctly?

  • Is PPE cleaned, maintained, and stored properly?

  • Have workers using PPE been trained in its proper use?

Fire Safety

  • Are all fire extinguishers currently up-to-date on their monthly checks?

  • Are fire extinguishers checked yearly by a 3rd party?

  • Is the fire extinguisher unobstructed and accessible?

  • Are the operating instructions on nameplate legible?

  • Is the nozzle and pin intact?

  • Does the gauge show in the green (Fully Charged)?

  • Are the fire alarm system and sprinkler system regularly tested?

  • Are there regular fire drills?

  • Smoking policy in place?

  • Is there a sprinkler system in place?

  • What company is responsible for completing sprinkler system checks?

  • Who is responsible for monthly safety inspections of Fire Extinguishers?

Floors and Walkways

  • Are walkways and stairways kept clear of obstructions?

  • Are buckets and mops available to clean up spills so no one will slip?

  • Are non-slip mats, grates, or slip-free coatings used in wet areas to revent falls?

  • Do stairways have handrails?

  • Are carpets and rugs causing a potential trip hazard?

Ergonomics and Manual Handling

  • Proper lifting techniques to prevent strains and sprains?

  • Use of mechanical aids and equipment to reduce manual handling tasks?

  • Stretching and warm-up exercises to prevent injuries?


  • Safety Consultant comments/feedbacks for report:

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.