Title Page

  • Conducted on

  • Type Of Inspection

  • Management

  • Union Rep

  • Inspector

  • Agency

  • Location

Citations

  • Please enter the citation information (photos are required)

  • Inspection Violation
  • What Department

  • Description

  • Type

  • Was the citation abated?

  • Due Date

  • Provide WO #, if completed.

Terminated Citations

  • If the inspector terminated any citations today, please provide the details here.

  • Terminated Citations
  • Where was the citations terminated? (Specific location)

  • What was the condition that was terminated? (Photo(s) will be required)

Inspector Recommendations

  • If the inspector provided any recommendations, please note them here.

  • Recommendations
  • Inspector Recommendations

Inspection Details

  • Please enter any equipment that was inspected during todays inspection.

Equipment

  • Summary of equipment inspected today.

  • Please enter any buildings or geographical markers to mp the areas inspected.

Buildings/Structures/Rooms/Areas

  • Summary of buildings and areas inspected.

Management Notes

  • Any additional notes that should be passed along. (Conditions not noted by the inspector but that need to be corrected)

  • Management Notes
  • Notes

Results Page

Inspection Summary

  • Please provide a summary of today's inspection.

  • Summary of Inspection

  • S&S Citations

  • How Many?

  • How many were abated?

  • Non-S&S Citations

  • How Many?

  • How many were abated?

Paperwork/Review/Daily Closeout

  • Were you issued any paperwork today?

  • Where was the paperwork turned in?

  • Comments/Concerns raised during the closeout

  • Notes

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.