Electrical & Fire
Power cords (3 prong, good condition, commercial grade only)?
Power strips with circuit breaker, no household extension cords (no daisy chaining=surge protector plugged into surge protector)?
Electrical panels (unobstructed, breakers labeled, no open breaker slots)?
GFCI outlets in wet areas (within 3 feet of sinks)?
18" clearance from fire sprinkler heads?
24" clearance from ceiling
Alarm pull-stations and fire extinguishers clearly identified and unobstructed?
Fire extinguisher (tamper seals in place, tags show inspection <1 year old, 3 feet clearance)?
Egress routes are clear (halls, stairwells, and exits unobstructed) minimum 28" clearance?
Emergency and exit lights functioning?
Evacuation maps posted?
Work area adequately illuminated (no blown bulbs)?
Ventilation (adequate, free fro dust and fumes, vent grills clean)?
No signs of water leaks in ceiling tiles, floor, or other areas?
Storage areas are organized and clean (no items of floor)?
Floor in good condition (no frayed carpet, loose tiles, slippery areas, etc.)?
No obvious slip, trip, or fall hazards?
No visible spills or utilization of wet floor signs for spills present?
First aid kit/AED with "no" expired products?
Recycling & trash bins orderly and not overflowing?
Rest rooms are clean?
Equipment in good condition (no frayed cords, broken plugs, etc.)?
Broken Equipment taken out of service until repaired?
All staff observed wearing ID badges with the pictures and names visible?
What does P-A-S-S stand for?
What does R-A-C-E stand for?
Where is the nearest fire pull station in your area?
Staff can locate the nearest fire extinguisher in your area?
Staff can identify the correct procedure in the event of a fire?
Staff has knowledge and uses Safety Data Sheets (SDSs)?
Staff can identify the number to call for security related incidents?
Hazardous chemical inventory up to date (within the past year)?
Secondary container (chemical containers) properly labeled?
Safety Data Sheets (SDSs) are current & available?
Proper training regarding chemicals before usage (ask an employee)?
Other Recognized Hazards
Other Recognized Hazards found?
ATTENTION: DEPARTMENT MANAGER
As Department Manager I have reviewed the survey noting any areas of non-compliance. Corrective action has been taken and documented appropriately on this form. When applicable, employee retraining has been conducted to maintain future compliance in these areas.