Title Page

  • Conducted on

  • Prepared by

  • Location

1. BUILDING EXTERIOR

  • Condition of exterior cladding?

  • Description

  • Is the exterior cladding clean?

  • Condition of windows?

  • Description

  • Are the windows clean?

  • Condition of Roof

  • Description

  • Is there a roof maintenance program?

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

  • Immediate action required?

  • Location and Description

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

  • Location and Description

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

2. DRIVEWAYS, PARKING LOTS, CARPORTS, GARAGES

  • Material in place to protect walls and supports?

  • Condition of padding?

  • 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?

  • Location and Description

  • 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Immediate action required?

  • 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Location and Description

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

  • Location and Description

5. GARBAGE AREA

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

  • Is this a safety hazard?

  • Description

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

  • Abandoned appliances or furniture on premises? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Location and Description

  • Garbage/recycling/hazardous materials signs posted? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • 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, or damaged anti-slip covering in place? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Is this a safety hazard?

  • Immediate action required?

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

  • Immediate Action Required?

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

  • Location and Description

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

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

  • Is this a trip hazard?

7. WALKWAYS AND LAWNS

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

  • Immediate action required?

  • Location and description

  • 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? . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Is this a safety hazard?

  • Location

  • 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? . . . .

  • Is this a safety hazard?

  • Immediate action required?

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 of personal property on balconies and decks? . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

  • Condition of leading edges of decks? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10. PLAYGROUND AND EQUIPMENT

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

  • Immediate action required?

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

  • Immediate action required?

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

  • Immediate action required?

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

  • Regular maintenance of equipment needed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11. POOL AND SPA

  • Are all gates self-latching?

  • Are all gates/doors self/closing?

  • Are pH and chlorine test records on site?

  • Is the pool drain protector in place?

  • Is the pool deck slippery or irregular?

  • Is this a safety hazard?

  • Are pool rules posted clearly?

  • Are depth markers in place?

  • Is the emergency phone in pool area operable?

  • Are all electrical outlets in covered and GFCI protected?

  • Is emergency shut off for spa operable?

12. SAUNA

  • 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 inspection current? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Location?

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

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

  • Smoke detectors in place and functioning properly? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Location?

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

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

  • Fireplace and BBQ ashes need to be disposed of properly? . . . . . . . . . . . . . . . . . . . . . . .

  • Automatic sprinkler system timer set appropriately?

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

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

  • Fireplaces in common areas equipped with screens? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

  • 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Is this a safety hazard?

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

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

18. LAUNDRY ROOM

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

  • 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

19. ELEVATORS

  • Condition of cab(s)

  • Description

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

  • Monthly service records maintained and in elevator mech. room? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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.