Title Page
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Document No.
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Conducted on
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Prepared by
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General housekeeping is good
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Comment
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Slip, trip, fall hazards
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Comment
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Mats/rugs secure
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Comment
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Switch/cover plates in place
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Take photo of problem area
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Comment
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Adequate lighting
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Take photo of problem area
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Comment
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Ventilation clean
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Comment
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Fire hoses/extinguishers checked
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Comment
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Equipment clearly marked
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Comment
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Fire equipment clear of blockage
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Comment
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No top-heavy filing cabinets
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Take photo of problem area
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Comment
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Drawers/cupboards closed
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Take photo of problem area
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Comment
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Light covers/ceiling tiles secure
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Comment
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Sufficient illumination level
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Comment
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Any burnt out bulbs
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Comment
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Emergency lighting operating
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Comment
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Locked or barred exits
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Comment
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Adequately illuminated exits
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Comment
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Exterior surfaces clear for prompt exit
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Take photo of problem area
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Comment
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Nothing blocking exits
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Comment
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Exit map for all locations
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Take photo of problem area
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Comment
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Any unsafe work practices observed
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Take photo of problem area
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Comment
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Inspector 1
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Inspector 2
