Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location


  • Are aisles, doorways and corners free of obstructions to permit visibility and movement?

  • Lighting in work area and walkways adequate?

  • Are chairs in safe condition and are caster, rungs and legs sturdy?

  • Are all equipment and supplies in their proper places?

  • Is there adequate walking and egress clearance? <br>A. 44 inches for corridors and stairways. <br>B. 36 inches for aisles. <br>C. 32 inches for doors

  • Are carts, dollies, etc. available for use in transporting heavy objects and boxes?

  • Is housing being adequately maintained?

  • Are SDS available for office and housekeeping chemicals?

  • Are SHEM posters prominently displayed?

  • Is the floor surface level and undamaged?

  • The floor is not wet or slippery? <br>A. A warning sign is available in case of spills? <br>B. Cleanup supplies are readily available? <br>C. Non slip mats are in entryways if needed?

  • Are carpets secured to floor and free of worn or frayed seams?

  • Are equipment or supplies stored so they don’t protrude into walkways?

  • Are cords or cables causing a trip hazard?

  • Are permanent user cords covered by runners when crossing walkways?

  • Is a step stool or ladder available to prevent the use of chairs for reaching high objects? Have employees been trained on the use of ladders?


  • Are 10 mA GFCI outlets w/in 6 feet of water source?

  • Is access to electrical panels unobstructed (at least 36 inches)?

  • Are outlets overloaded?

  • Extension cords are not used in lieu of fixed wiring?

  • A minimum of one power strip per electrical receptacle is used? (no daisy chains)

  • Electrical cords and plugs are in good condition? (I.e not frayed, taped, spliced, or missing ground prongs)

  • Electrical receptacles are in good working condition?

  • Are electrical equipment in good working condition?

  • Are electrical closets free of storage?

  • Are personal appliances such as space heater or coffee makers compliant with the buildings electrical circuit system?

  • Are transformers on non-combustible surfaces?

  • Are space heaters equipped with an overheat sensor?

MAINTENANCE (outside and inside)

  • Are doors and locks in good working order?

  • Are ceiling tiles intact, undamaged, and in place?

  • Are there no signs of water damage or mold growth in the facility?

  • Are all windows unbroken and free from any type of damage?

  • Do ventilation supply diffusers and returns appear to be functional? Is the airflow adequate and in the proper direction (outward for the consular area)?

  • Are outside lights in good working order?

  • Does the exterior of the building present no safety concerns?

  • Is the parking lot area free of any safety concerns? (I.e uneven pavement, broken sidewalls, traffic hazards)


  • Are computer lights in good working condition?

  • Are computer workstations equipped with keyboard trays?

  • Do employee know how to adjust their chairs and keyboard trays?

  • Do any chairs appear to be too large or too small for the users?

  • Do any employees appear to be leaning forward, bending or looking to the side to see monitor or documents on desktop?

  • Are chairs, keyboards trays and monitors aligned?

  • Do windows have window coverings to control outdoor light levels

  • Have any employees reported discomfort from using their workstation?


  • Are exits signs illuminated and visible?

  • Are corridors and egress ways free from obstructions and exit unlocked?

  • Access to exit doesn’t require travel through high hazard area?

  • Stairways are in good condition repair with handrails and non-slip tread?

  • Stairways are not being used for storage?

  • Stairways steps are uniform in size?

  • Is the emergency evacuation route and action plan posted?

  • Are exit doors closed and not propped open?

  • Is there any obvious damage to the sprinklers?

  • Are fire extinguishers easily accessible, checked monthly and operational?

  • Are fire extinguishers mounted so that the travel distance from employees to any extinguisher is 75 feet or less


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.