Title Page

  • Conducted on

  • Prepared by

  • Location

MAIN OFFICE:

  • Anticipated Staffing:

  • # of Private Offices:

  • # of Cubicles/Desks:

Restrooms (Office):

  • Urinals for Men:

  • Stalls for Men:

  • Stalls for Women:

  • Showers:

Restrooms (Warehouse)

  • Urinals for Men:

  • Stalls for Men:

  • Stalls for Women:

  • Showers:

IT Closet:

  • Size:

  • Dedicated HVAC:

  • Vents:

  • Fans:

  • Power:

  • Type of Power:

Miscellaneous:

  • Supply Closet:

  • Conference Room:

  • Conference Room Size (# of seats):

  • Vestibule:

  • Break Room:

  • Break Room Size:

  • Appliances:

  • Appliance Type:

  • Cabinetry:

  • Water Fountain/Water cooler:

  • Additional Power requirements:

  • Training Room:

  • Training Room (# of seats):

  • Second Floor:

  • First/Second Floor ADA Compliance:

Finishes:

  • VCT:

  • Carpet:

  • Paint Preferences:

  • Door Preferences:

  • Additional Finish Requirements:

Site Condition

  • Warehouse Condition

  • Warehouse Floor Condition

  • Warehouse Wall Condition

  • Warehouse Floor Sealed

  • Warehouse Floor Condensation

  • Striping/Tape left on WH Floor from prior tenant

  • Warehouse Wall Condition

  • Staging Lanes Available

  • Staging Lane Size

  • Cobwebs Visible

  • Dock Doors in good working order

  • Dock Levelers in good working order

  • All lights functioning throughout site (interior/exterior)

  • Office Condition

  • Office Wall Condition

  • Office Floor Condition

  • HVAC Age

  • Ceiling Tile Condition

SHIPPING/RECEIVING OFFICE:

  • Location within WH:

  • Driver Lounge:

  • Driver Lounge Separate Entrance from Exterior:

  • Driver Lounge Restricted Access to Warehouse:

  • Driver Lounge Window to clerk:

  • Restrooms (SRO):

  • Urinals for Men:

  • Stalls for Men:

  • Stalls for Women:

OTHER:

  • Scrubber Dump:

  • Design (sink vs floor pan, etc):

  • Scrubber Dump Separator:

  • Plumbing for Water fountain/cooler:

  • Full Shower/Eyewash (if electrical MHE is used)

EXTERIOR:

  • Landscape:

  • Awning over Employee Entrances:

  • Awning over Dock Door Bumpers:

  • Drainage Pipe Locations:

  • Break Area:

  • Perimeter Fence:

  • Gate:

  • Auto Gate:

  • Manual Gate:

  • Parking Lot Drainage:

DOCK EQUIPMENT:

  • # of Dock Doors:

  • Locations/Sides:

  • Type:

  • Capacity:

  • Width (minimum of 9 feet is required):

  • Drive-In Doors (Ramps)

Dock Packages

  • Levelers:

  • Leveler Type:

  • Shelters/Awning:

  • Z guards/Bollards at Doors:

  • Swing Arm Lights at Door Locations:

  • Electrical at Door Locations:

  • Air Lines at Door Locations:

  • Brush Seals at All Dock/Man Door Locations:

  • Dock Bumpers

  • Dock Door Fan at Door Locations

  • Dock Locks

  • Dock Locks Locations:

  • Dock Light Type (manual/auto, red/green lights, etc):

  • Numbers on Dock Exterior Locations:

  • Numbers on Dock Interior Locations:

  • Trailer Parking Striping

ELECTRICAL REQUIREMENTS:

  • # of Drop Outlets in Warehouse:

  • Drop Locations in Warehouse:

Additional Power requirements for equipment

  • Cart Caddy:

  • Scrubber:

  • Trash Compactor:

  • Baler:

  • Stretch Wrapper:

  • Kitting Area:

  • IT(RF) in Warehouse:

  • Supervisor bullpen:

  • Product Charging Requirements:

Additional requirements:

  • Generator:

  • Size (what items need to powered):

Interior Lighting:

  • Auto On/Off:

  • Foot Candles at Floor Level:

  • Drop Lighting required for additional activity:

Automatic Emergency Egress Lighting:

  • Automatic Overhead, within Aisles:

  • Automatic Overhead, randomly spaced:

  • Bugeye:

Exterior Lighting:

  • Candlepower on Building:

  • Candlepower at Employee Entrances:

  • Candlepower for pole lights (truck court/employee parking):

PARKING:

  • # of Auto Parking Locations:

  • #of Trailer Parking Locations (excluding dock positions):

  • Dolly Pad (with concrete):

  • Block Heater Plugs Available (North Locations)

Trailer Parking Numbering:

  • Painted on Pavement:

  • Posts:

  • Hanging Signs:

FOOD GRADE/MEDICAL:

  • DEA/FDA Environment:

  • Any specific site level certifications:

  • Caulked Floor Joints:

  • Rodent Run width:

  • Gravel exterior perimeter width:

  • Shatterproof bulbs:

  • Brushes on Levelers:

  • Screen on Louvers:

  • Brushes on Man Doors:

  • Bug Lights near Man Doors:

  • Interior/Exterior Rodent/Bug Traps:

TEMPORARY REQUIREMENTS: If necessary

Temporary Office Trailer:

  • Size:

  • Dates needed:

  • Concerns around CoO (Certificate of Occupancy):

  • Concerns around HPSP (High Pile Storage Permit):

SAFETY/SECURITY/RISK RELATED

  • C-TPAT Compliance:

  • Bollards at all electrical panels and internal downspouts:

  • Railing/bollards for associates protection:

  • Column Paint:

  • Column Paint Height:

  • Additional Safety/Security/Risk Requirements:

  • Eyewash Stations:

Employee entrance requirements:

  • Badge Entry at employee entrance:

  • Badge Entry at SRO location:

  • Badge Entry at other locations:

  • Cameras:

  • Camera Locations:

  • Camera Electrical requirements:

  • Guard Shack:

  • Guard Shack Restroom:

  • Guard Shack Electrical Requirements:

  • Facility Gate:

  • Facility Gate style (Manual/Auto):

  • Perimeter Fence:

  • Perimeter Fence Location (Surrounds whole site):

  • Perimeter Fence Material:

  • Additional gates:

  • Interior Shelter Available (in case of storm)

RISK MANAGEMENT:

  • # of Air changes per hour:

  • Big Overhead Fans:

  • # of Big Overhead Fans

  • Required to interlock to Fire Suppression by LL:

  • Warehouse Air Conditioning

  • Warehouse Area to be conditioned:

  • WH Temp Range:

  • WH Humidity Control Range:

  • Firewall/Demising Wall Requirements:

  • Containment/Specialty Room Requirements:

  • Drop Ceiling:

  • Special Fire Suppression concerns:

  • Sprinkler Class Type:

  • # Sprinkler Heads:

  • Sprinkler Head Size:

  • Other Sprinkler Requirements:

Building construction and product compatibility:

  • Issues with other product in building:

  • Exhaust fans within Building:

  • Exhaust Fans Connected to Fire Suppression:

  • Exhaust Fans Adequate for Product:

  • Exhaust Fans Adequate for High Pile Storage:

MHE/Racking Requirements/Specifications

MHE:

  • Forklifts:

  • Scrubber

  • Cart Caddy

  • Pallet Jacks

  • Motorized Pallet Jack

  • Hand Dollies

  • People Movers (Golf Carts, etc.)

  • Specialized Attachments (Forks, Clamps, FLEX, etc.)

  • Propane for MHE

  • Propane Tank Onsite

  • Propane Cage Onsite

  • Battery Chargers for MHE

  • Battery Charger Power requirements:

  • Battery Charging Area Epoxy:

  • Battery Charging Area Exhaust fans:

Racking:

  • Standard Pallet Locations:

  • Other Sized Pallet Locations:

  • Weight capacity per Pallet Location/Level:

  • Rack Guards:

  • Racking Labels:

  • Racking Label Type: Stickers:

  • Racking Label Type Magnetic:

  • Stow Location Labels:

  • Stow Location Type: Floor

  • Stow Location Type: Hanging

  • Floor capacity concerns:

  • Sprinkler Modifications Needed:

  • In-Rack:

Other

Signage:

  • Interior Branding:

  • Interior Signage:

  • Exterior Branding: Building Window

  • Exterior Branding: Building Sign

  • Exterior Branding: Monument Sign

Building:

  • Zoning/permits required:

  • HPSP Required:

  • Fire Safety Requirements:

  • City Permits Required:

  • County Permits Required:

  • State Permits Required:

  • Cell Service within Building

Environment:

  • Exit to Traffic Signal:

  • Near Wooded Area:

  • Street Well Lit:

  • Traffic Congestion Present:

  • Room for Trucks to turn out of site:

  • Room for Trucks to turn into site:

  • Turning Lane Present:

  • Acceleration Lane Present:

  • Close to highway(s):

  • Near Farms:

  • Near Ranch:

  • Extraneous Scents Present:

  • Extraneous Insects Present:

  • Near Truck stops (within 15 miles):

  • Near Ryder Location(s) (within 10 miles):

  • Near Outsource Carrier Location(s):

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.