Information

  • Document No.

  • Conducted on

  • Personnel

  • Are the handrails leading up to the main entrance of the plant free from damage?

  • Can or did you fix the problem?

  • Who did you contact?

  • As you enter the main entrance, is the exit sign working properly?

  • Can or did you fix the problem?

  • Who did you contact?

  • Is the lighting in the foyer working properly?

  • Can or did you fix the problem?

  • Who did you contact?

  • Proceed through the west door into the office hallway. Is the lighting in the offices and hallway working properly?

  • Can or did you fix the problem?

  • Who did you contact?

  • As you enter Room 106, are the exit signs above both doors working properly?

  • Can or did you fix the problem?

  • Who did you contact?

  • On the west wall of Room 106, is E-light EL-103 working properly?

  • Can or did you fix the problem?

  • Who did you contact?

  • In the north hallway, next to Room 104, is E-light EL-102 working properly?

  • Can or did you fix the problem?

  • Who did you contact?

  • Is fire extinguisher F-03 in its signaled location, unblocked, fully charged and pin/seal intact?

  • Can or did you fix the problem?

  • Who did you contact?

  • Moving west into the open office area, is the lighting working properly?

  • Can or did you fix the problem?

  • Who did you contact?

  • Along the north wall, above the door to Room 116, is E-light EL-101 working properly?

  • Can or did you fix the problem?

  • Who did you contact?

  • On the west side of the room, is E-light EL-105 working properly?

  • Can or did you fix the problem?

  • Who did you contact?

  • Just beyond the Scheduling Office, is the exit sign above the exit door working properly?

  • Can or did you fix the problem?

  • Who did you contact?

  • As you enter the Scheduling Office, is the lighting in Room 118 working properly?

  • Can or did you fix the problem?

  • Who did you contact?

  • Is the lighting in Room 119 working properly?

  • Can or did you fix the problem?

  • Who did you contact?

  • Is the lighting in Room 120 working properly?

  • Can or did you fix the problem?

  • Who did you contact?

  • Next to the window on the north wall, is fire extinguisher SCH-1 in its signaled location, unblocked, fully charged and pin/seal intact?

  • Can or did you fix the problem?

  • Who did you contact?

  • Move back into the open office area and into the Phone Room 117. Is fire extinguisher PH-1 in its signaled location, unblocked, fully charged and pin/seal intact?

  • Can or did you fix the problem?

  • Who did you contact?

  • Is the lighting in Room 117 working properly?

  • Can or did you fix the problem?

  • Who did you contact?

  • Exit the Phone Room and proceed to Room 112. Is the lighting working properly?

  • Can or did you fix the problem?

  • Who did you contact?

  • Move south into the Mail Room. Is the lighting working properly?

  • Can or did you fix the problem?

  • Who did you contact?

  • Is fire extinguisher FO-1 in its signaled location, unblocked, fully charged and pin/seal intact?

  • Can or did you fix the problem?

  • Who did you contact?

  • Proceed to the south side of the room and into the south hallway. Is the lighting in the offices and hallway working properly?

  • Can or did you fix the problem?

  • Who did you contact?

  • Proceeding east down the hallway, is E-light EL-104 working properly?

  • Can or did you fix the problem?

  • Who did you contact?

  • To the east of Room 107, is fire extinguisher FO-2 in its signaled location, unblocked, fully charged and pin/seal intact?

  • Can or did you fix the problem?

  • Who did you contact?

  • At the east end of the hallway, in the women's restroom, is E-light EL-121 working properly?

  • Can or did you fix the problem?

  • Who did you contact?

  • In the men's restroom, is E-light EL-122 working properly?

  • Can or did you fix the problem?

  • Who did you contact?

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.