Municipal Services Building Safety Audit Form

• Document No.

• Conducted on

  Date

• Prepared By

  Select Danny Maltby Rick Maloy David Chandler Arron Johnson

  • Danny Maltby
  • Rick Maloy
  • David Chandler
  • Arron Johnson
• Location
  Address

Wash Bay

• Pressure Washer Hoses

  Safe

  At Risk

  N/A

• Heater chains - visual

  Safe

  At Risk

  N/A

• Cleanliness

  Safe

  At Risk

  N/A

North Shop

• Fire Extinguishers

  Safe

  At Risk

  N/A

• Air Lines Clear From Floors

  Safe

  At Risk

  N/A

• Heater Chains Visual

  Safe

  At Risk

  N/A

• Chemical/Fuel Storage - Visual

  Safe

  At Risk

  N/A

• Battery Chargers - Placement

  Safe

  At Risk

  N/A

• Trip Hazards - Visual

  Safe

  At Risk

  N/A

• Trip Hazards - Visual

  Safe

  At Risk

  N/A

• Fluid Spills - Visual

  Safe

  At Risk

  N/A

• Rack Storage - Visual

  Safe

  At Risk

  N/A

Maintenance Yard

• Tire Puncturing Objects

  Safe

  At Risk

  N/A

• Stacked Items in Sheds

  Safe

  At Risk

  N/A

• Loose Material on Ground

  Safe

  At Risk

  N/A

• Any Other Safety Hazards

  Safe

  At Risk

  N/A

Fleet Shop

• Fire Extinguishers

  Safe

  At Risk

  N/A

• Fluid Spills

  Safe

  At Risk

  N/A

• Any Other Safety Hazards

  Yes

  No

  N/A

South Parking Lot

• Light Poles, Push Test

  Safe

  At Risk

  N/A

• Curb Condition - Winter

  Safe

  At Risk

  N/A

• Handicap Signs - Push Test

  Safe

  At Risk

  N/A

• Power and Traffic Box - Visual

  Safe

  At Risk

  N/A

• Landscaping - Clearance

  Safe

  At Risk

  N/A

• Flag Pole - Push Test

  Safe

  At Risk

  N/A

• Parking Stalls - Paint

  Safe

  At Risk

  N/A

Office Area

• Foyer - Fire Plan

  Safe

  At Risk

  N/A

• Exit Light - Test

  Safe

  At Risk

  N/A

• Aisles - Clear

  Safe

  At Risk

  N/A

• Filing Cabinets - Overloaded/ Top Heavy

  Safe

  At Risk

  N/A

• Bookshelf - Overloaded / Top Heavy

  Safe

  At Risk

  N/A

• Electrical Connections - Cubicles

  Safe

  At Risk

  N/A

• Electrical Inspection - Flammable Materials

  Safe

  At Risk

  N/A

Multi-Purpose Room/ Kitchen

• Floor Outlet Covers - Flush

  Safe

  At Risk

  N/A

• Wheels on Chairs - Visual

  Safe

  At Risk

  N/A

• Exit Light - Test

  Safe

  At Risk

  N/A

• Fridges - Stacking on Top

  Safe

  At Risk

  N/A

Restrooms/ Locker Rooms

• Broken Tile - Visual

  Safe

  At Risk

  N/A

• Dividers - Secure

  Safe

  At Risk

  N/A

Welding Bay

• Electrical Room - Locked

  Safe

  At Risk

  N/A

• Heater Chains - Visual

  Safe

  At Risk

  N/A

• Floor Drain Grates - In Place

  Safe

  At Risk

  N/A

• Cylinders - Caps On

  Safe

  At Risk

  N/A

• Eye Wash - Test

  Safe

  At Risk

  N/A

• Fire Extinguisher - Check

  Safe

  At Risk

  N/A