Life Safety Audit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Receiving

Fire Extinguisher by the Employee Entry Door

• Is the gauge in the green area, indicating the fire extinguisher is appropriately charged?

  Yes

  No

  N/A

• Has an inspection been completed within the last 30 days?

  Yes

  No

  N/A

• Has it been inspected by an outside service within the last 12 months?

  Yes

  No

  N/A

• Has a CMMS service request been submitted?

  Yes

  No

  N/A

• What is the CMMS service request number?

Exit Light Hanging Near Receiving Office

• Is the exit light in receiving lit?

  Yes

  No

  N/A

• Is it hanging properly?

  Yes

  No

  N/A

Lock Out/ Tag Out Kit

• Was the LockOut/Tag Out Kit inspected within the last 30 days?

  Yes

  No

  N/A

• Does it contain two yellow lock out boxes?

  Yes

  No

  N/A

• Does it contain two red lock out boxes?

  Yes

  No

  N/A

• Does it contain a yellow lock and key?

  Yes

  No

  N/A

• Does it contain a red lock and key?

  Yes

  No

  N/A

• Does it contain a blue lock and key?

  Yes

  No

  N/A

• Does it contain a green lock and key?

  Yes

  No

  N/A

Lock Out/Tag Out Log

• Is any of the equipment locked out/tagged out?

  Yes

  No

  N/A

• Is any equipment locked out?

  Yes

  No

  N/A

• Has the locked out equipment been logged?

  Yes

  No

  N/A

• Does the log match the log in the cash office?

  Yes

  No

  N/A

Receiving Bay Doors