MAINTENANCE MONTHLY INSPECTION

• MAINTENANCE

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Smoke Detectors

  Yes

  No

  N/A

• Heat Sensors

  Yes

  No

  N/A

• Pull Stations

  Yes

  No

  N/A

• Strobes

  Yes

  No

  N/A

• Fire Extinguishers

  Yes

  No

  N/A

• Emergency Lights

  Yes

  No

  N/A

• Exit Lights

  Yes

  No

  N/A

• Carbon Monoxide Detectors (if applicable)

  Yes

  No

  N/A

• Electrical Outlets

  Yes

  No

  N/A

• Electrical Panels Labeled/No missing Breakers/Blocked with in 36 inches?

  Yes

  No

  N/A

• Lighting

  Yes

  No

  N/A

• Facility Exits

  Yes

  No

  N/A

• Facility Exit Plan Posted

  Yes

  No

  N/A

• SDS Binder Accessible/Index Current

  Yes

  No

  N/A

• Chemicals Stored and Labeled Properly

  Yes

  No

  N/A

• Broken Glass

  Yes

  No

  N/A

• Proper Use of Extension Cords/Surge Protectors

  Yes

  No

  N/A

• Trip Hazards

  Yes

  No

  N/A

• Walls – Ceilings – Floors

  Yes

  No

  N/A

• Doors/Door Closers/Hardware

  Yes

  No

  N/A

ENVIROMENTAL SAFETY

• Facility Cleanliness

  Yes

  No

  N/A

• Trash Containers

  Yes

  No

  N/A

• Urinals – Commodes

  Yes

  No

  N/A

• Microwaves

  Yes

  No

  N/A

• Refrigerators

  Yes

  No

  N/A

• Cleaning Supplies / Storage

  Yes

  No

  N/A

• HVAC Vents

  Yes

  No

  N/A

• Floor Coverings

  Yes

  No

  N/A

• Outside Area – cleanliness - safe

  Yes

  No

  N/A

• PPE in good condition

  Yes

  No

  N/A

• No defective electrical cords

  Yes

  No

  N/A

• Hand Tools serviceable

  Yes

  No

  N/A

• Power tools have guards in place

  Yes

  No

  N/A

• Power tool cords and plugs in good condition

  Yes

  No

  N/A

• Unserviceable broken tool removed from service

  Yes

  No

  N/A

• Extension cords serviceable

  Yes

  No

  N/A

• Power plugs serviceable (GFCI if applicable)

  Yes

  No

  N/A

• Lockouts used as needed

  Yes

  No

  N/A

• JHA available for operations

  Yes

  No

  N/A

• Flammable Storage: No combustibles or nonflammable items stored in cabinet. No items stored on cabinet. Plugs installed

  Yes

  No

  N/A

• Fire Alarm panel good, no faults

  Yes

  No

  N/A

undefined

• undefined