Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Electrical outlets are not over loaded.

  • Action Item Description

  • Person Responsible

  • Due Date

  • Electrical extension cords in good order and not overloaded

  • Action Item Description

  • Person Responsible

  • Due Date

  • If applicable, storage boxes stacked to safe height, and items are stored safely on shelves and filing cabinets.

  • Action Item Description

  • Person Responsible

  • Due Date

  • Electrical/Furnace room free of debris in front of furnace room free of debris in front of furnace,breaker boxes easily accessible

  • Action Item Description

  • Person Responsible

  • Due Date

  • Chairs and desks in good safe condition

  • Action Item Description

  • Person Responsible

  • Due Date

  • Rugs are free from holes holes and tears

  • Action Item Description

  • Person Responsible

  • Due Date

  • Paper products safe distance from heat source

  • Action Item Description

  • Person Responsible

  • Due Date

  • Fire extinguishers location is marked correctly

  • Action Item Description

  • Person Responsible

  • Due Date

  • Fire extinguisher in good order

  • Action Item Description

  • Person Responsible

  • Due Date

  • Smoke detectors checked monthly and recorded

  • Action Item Description

  • Person Responsible

  • Due Date

  • Office hazard assessment is posted

  • Action Item Description

  • Person Responsible

  • Due Date

  • First aid kit/eye wash station fully stocked in good order and unobstructed

  • Action Item Description

  • Person Responsible

  • Due Date

  • List of first aiders is posted near first aid kit

  • Action Item Description

  • Person Responsible

  • Due Date

  • First aid recording booklet is being used. Copies have been scanned and emailed to the Camrose safety coordinator for filing

  • Action Item Description

  • Person Responsible

  • Due Date

  • Near miss and accident reporting procedures are posted, staff knows where to get forms if necessary

  • Action Item Description

  • Person Responsible

  • Due Date

  • Entrance/exits clear and unobstructed

  • Action Item Description

  • Person Responsible

  • Due Date

  • Walkways free of tripping hazards

  • Action Item Description

  • Person Responsible

  • Due Date

  • Most current Health and Safety committee meeting minutes are posted

  • Action Item Description

  • Person Responsible

  • Due Date

  • EAP (emergency action plan) posted in visible area. EAP practiced minimum once per year

  • Action Item Description

  • Person Responsible

  • Due Date

  • Workers observed using proper body ergonomics when sitting,typing, lifting, etc

  • Action Item Description

  • Person Responsible

  • Due Date

  • Auditor Signature

  • Manager Signature

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