Information
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
Fire extinguishers
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Are all fire extinguishers fully charged and in their designated places?
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Are fire extinguishers accessible?
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Is the number of fire extinguishers adequate?
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Are extinguishers clear of obstructions?
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Are fire extinguishers inspected and maintained regularly?
Medical Services and First Aid
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Is there a hospital or clinic for medical care near your workplace or is at least one employee on each shift currently qualified to render first aid?
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Have all employees who are expected to respond to medical emergencies as part of their job responsibilities received first aid training; had hepatitis B vaccination made available to them; had appropriate training on procedures to protect them from bloodborne pathogens; and have available and understand how to use appropriate PPE to protect against exposure to bloodborne diseases?
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Are emergency phone numbers posted?
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Are first aid kits easily accessible, periodically inspected and replenished as needed?
Emergency Exits
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Are emergency exits clearly marked?
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Are illuminated exit signs working properly?
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Are all exits free of obstructions?
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Are there sufficient exits to permit prompt escape in case of emergency?
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Are exit doors able to be opened from the direction of exit travel without the use of a key or any special knowledge or effort when the building is occupied?
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When panic hardware is installed on a required exit door, will it allow the door to open by applying a force of 15 pounds or less in the direction of travel?
Hallways and Lobby
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Are hallways clear of obstructions and trip hazards?
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Is hallway lighting adequate?
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Is lobby free of obstructions and trip hazards?
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Is lobby lighting adequate?
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Are emergency phone numbers readily available?
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Are emergency exits clearly marked?
Classrooms
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Are classrooms tidy and free of obstructions and trip hazards?
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Are covers installed on electrical receptacles?
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Are locks installed on cabinets containing any hazardous materials?
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Are chemicals properly stored and labeled?
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Is furniture in good condition?
Storage
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Is storage tidy and free of obstructions and trip hazards?
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Is storage area accessible to children?
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Are gas bottles secured?
Hazardous Substances Communication
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Is there a list of hazardous substances used in your workplace and an SDS readily available for each hazardous substance?
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Is there a current written exposure control plan for occupational exposure to bloodborne pathogens and other potentially infectious materials, where applicable?
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Is each container for hazardous substance (i.e., vats, bottles etc.) labeled with product identity and a hazard warning (communication of the specific health hazards and physical hazards)?
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Are chemicals properly stored and labeled?
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Are all secondary containers properly labeled?
Electrical rooms and panels
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Are electrical rooms free of obstructions?
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Is there a 3 foot minimum clearance around electrical panels?
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Are all panel openings enclosed and live components covered?
Completion
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Conducted by: