Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Electrical outlets are not over loaded.
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Action Item Description
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Person Responsible
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Due Date
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Electrical extension cords in good order and not overloaded
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Action Item Description
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Person Responsible
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Due Date
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If applicable, storage boxes stacked to safe height, and items are stored safely on shelves and filing cabinets.
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Action Item Description
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Person Responsible
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Due Date
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Electrical/Furnace room free of debris in front of furnace room free of debris in front of furnace,breaker boxes easily accessible
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Action Item Description
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Person Responsible
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Due Date
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Chairs and desks in good safe condition
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Action Item Description
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Person Responsible
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Due Date
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Rugs are free from holes holes and tears
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Action Item Description
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Person Responsible
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Due Date
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Paper products safe distance from heat source
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Action Item Description
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Person Responsible
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Due Date
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Fire extinguishers location is marked correctly
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Action Item Description
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Person Responsible
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Due Date
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Fire extinguisher in good order
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Action Item Description
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Person Responsible
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Due Date
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Smoke detectors checked monthly and recorded
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Action Item Description
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Person Responsible
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Due Date
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Office hazard assessment is posted
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Action Item Description
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Person Responsible
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Due Date
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First aid kit/eye wash station fully stocked in good order and unobstructed
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Action Item Description
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Person Responsible
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Due Date
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List of first aiders is posted near first aid kit
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Action Item Description
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Person Responsible
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Due Date
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First aid recording booklet is being used. Copies have been scanned and emailed to the Camrose safety coordinator for filing
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Action Item Description
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Person Responsible
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Due Date
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Near miss and accident reporting procedures are posted, staff knows where to get forms if necessary
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Action Item Description
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Person Responsible
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Due Date
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Entrance/exits clear and unobstructed
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Action Item Description
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Person Responsible
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Due Date
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Walkways free of tripping hazards
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Action Item Description
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Person Responsible
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Due Date
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Most current Health and Safety committee meeting minutes are posted
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Action Item Description
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Person Responsible
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Due Date
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EAP (emergency action plan) posted in visible area. EAP practiced minimum once per year
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Action Item Description
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Person Responsible
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Due Date
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Workers observed using proper body ergonomics when sitting,typing, lifting, etc
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Action Item Description
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Person Responsible
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Due Date
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Auditor Signature
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Manager Signature