Title Page

  • Conducted on

  • Prepared by

  • Location

1. BUILDING EXTERIOR

  • Condition of exterior cladding?

  • Description

  • Is the exterior cleaning regularly?

  • Condition of windows?

  • Description

  • Are the windows cleaned regularly?

  • Condition of Roof

  • Description

  • Is there a roof maintenance program?

  • Broken or cracked window glass? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Immediate action required?

  • Missing or damaged window screens? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Barred windows equipped with interior releases operable? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2. DRIVEWAYS, PARKING LOTS, CARPORTS, GARAGES

  • Controls in place to protect walls and supports?

  • Description

  • Wheel stops in proper position/secured, speed bumps and painted a contrasting color?.

  • Description

  • Grease and oil spots controlled?

  • Evidence of waste oil dumping?

  • Lighting covers all public areas?

  • All cars properly parked in marked spaces?

  • Abandoned and inoperative cars present?

  • Driveway surfaces free of pot holes and uneven surfaces?

  • Description

  • Vegetation pruned back to reduce blind spots?

  • Gas meters protected to prevent damage by vehicles. i.e. concrete posts?

  • Height limits posted over garage and carport openings?

  • Snow removed as needed in winter weather?

3. SECURITY/PRIVACY GATES:

  • Safety devices in place and adjusted? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Description

  • Emergency access available for fire and police? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Immediate action required?

  • Description

  • Manual operating procedures available for gates if power fails? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Driveway gates have stop signs posted on both sides? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Vehicle gate condition?

  • Description

  • Automatic gates have sign posted “CAUTION: AUTOMATIC GATE”? . . . . . . . . . . . . . . . . . . . . . . . . .

  • Pedestrian door(s) condition?

  • Description

4. Doors and Locks

  • Utility and maintenance room doors kept closed and locked? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Common area doors and locks functioning properly? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Emergency exits properly marked? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5. GARBAGE AREA

  • Area clean: no broken glass or slippery liquids? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Dumpster lids kept closed and wheels locked? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • No abandoned appliances or furniture? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • No signs of hazardous materials being dumped? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Vegetation cleared away from tops and sides of dumpsters? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Dumpsters kept away from building walls? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Dumpster Condition

  • Description

6. STAIRS AND HANDRAILS

  • Any loose stairs, anti-slip covering in place? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Any loose or missing railings? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Any combustibles storaged under stairs? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Lighting appropriate for conditions? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Carpet secure and in good condition? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7. WALKWAYS AND LAWNS

  • Free of trip and fall hazards - uneven surfaces? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Immediate action required?

  • Standing water on walkways surfaces? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Immediate action required?

  • Ground cover and bushes kept off walkway surfaces? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Lawn sprinkler protrude above ground in any pedestrian area? . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Lighting illuminates all anticipated walking surfaces? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Immediate action required?

  • Step up/step down areas properly protected by railings and/or indicated by bright, contrasting paint? . . . .

8. LANDSCAPING, TREES, BUSHES, HEDGES, GROUND COVER

  • Gutters and roofs clear of leaves and debris? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Trees pruned away from roofs, eaves or buildings? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Immediate action required?

  • Lower branches of trees removed to a minimum of seven feet above sidewalk? . . . . . . . . . . . . . . . . . . . . .

  • Immediate action required?

  • Bushes and hedges pruned back to reduce hiding places? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Brush cleared to 30 feet from buildings? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Poison oak/ivy removed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Tree roots exposed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Immediate action required?

9. BALCONIES AND DECKS

  • Potted plants on railings or decks? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Storage on balconies and decks? . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Flammable liquid storage? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Condition of railings in place? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Condition of leaking edges of decks? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10. PLAYGROUND AND EQUIPMENT

  • Equipment secured to ground? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Shock-absorbing base beneath equipment? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Equipment inspected for worn, loose or missing components?.............................................................

  • Glass, animal feces and other litter cleaned up? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Regular documented inspections of equipment? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11. POOL AND SPA

  • Fences around pool and spa in good condition? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12. SAUNA

  • Checked daily for serviceability? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Lighting adequate? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Door(s) open easily and benches free of splinters? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Rules posted for users’ reference? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Thermostat functional and visible to user? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Immediate action required?

  • Window is present and clear? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Health warning signs posted? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13. LIGHTING

  • Adequate lighting present in all outdoor areas? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Immediate action required?

  • Lighting time-clock adjusted at regular intervals for daylight changes? . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • All porch lights covered and equipped with properly sized bulb? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Hot bulbs/fixtures out of reach? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Circuit breakers properly labeled? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Is emergency lighting operational? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Immediate action required?

14. FIRE SYSTEMS AND PREVENTION

  • Fire extinguishers of appropriate size and type available? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Fire extinguishers serviced once a year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Expired?

  • Alarm bells identified and painted a contrasting color? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Local fire alarm serviced? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Smoke detectors in place and functioning tested monthly? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Flammable liquids allowed in storage areas? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Combustible weeds or debris on property? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Fireplace and BBQ ashes need to be disposed of in separate metal containers? . . . . . . . . . . . . . . . . . . . . . . .

  • Automatic sprinkler system regularly inspected and tested by qualified personnel?

  • Fireplaces and chimneys inspected/cleaned annually? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Vegetation cleared within 10 feet of chimneys? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Spark arrestor caps in place? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Fireplaces equipped with screens inspected annually? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15. LOBBY AND HALLWAYS

  • Is the lobby clean, walls, floors, fixtures?

  • Description

  • Lobby furniture broken or in need of repair?

  • Description

  • Lobby flooring clean and undamaged?.

  • Description

  • Hallways clean, walls, ceiling and fixtures?

  • Description

  • Hallway flooring clean and undamaged?

  • Description

  • Fixtures in good condition?

  • Description

16. AMENITIES, CLUB ROOM, SOCIAL FACILITIES

  • Area checked daily for condition? (i.e., kitchen etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Condition of room, furniture, flooring and fixtures?

  • Description

  • Facilities inspected after each use or function? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Rules posted for users’ reference? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

17. FITNESS ROOM

  • Equipment condition -worn, loose or missing components? . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Defective equipment present? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Rules posted for users’ reference? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Lighting adequate? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18. LAUNDRY ROOM

  • Lighting adequate? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • “NO SMOKING” signs posted? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Metal garbage cans provided with self-closing lids? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Dryer lint screens clean? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Dryer vents unobstructed, connected and clean? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Doors closed and locked when unattended? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • No storage within 18 inches of the water heaters? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Water heater burner door in place? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Area behind dryers and washers kept clean? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Dryer motor and related parts cleaned and lubricated semi-annually? . . . . . . . . . . . . . . . . . . . . . . . . . . . .

19. ELEVATORS

  • Condition of cab(s)

  • Description

  • Annual inspection certificate posted in car? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Monthly service records maintained? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • “NO SMOKING” signs posted? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Wide-lipped, sand-filled ash trays provided on each floor outside elevator doors? . . . . . . . . . . . . . . . . . . .

  • Signs posted “In The Event of Fire” do not use? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20. HEATING AND AIR CONDITIONING

  • Utility Room clean and free of debris? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Description

  • Systems/pumps regularly serviced? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Water heaters or boilers inspected annually? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

REPORT OF UNSAFE CONDITIONS

  • Item 1 - Description

  • Item 2 - Description

  • Item 3 - Description

  • Item 4 - Description

  • Item 5 Description

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.