Quarterly Safety Inspection Checklist

• Audit Title

• Facility

• Address
  Address

• Conducted on

  Date

• Prepared by

General Environmental Controls

• Are waste containers emptied regularly?

  Yes

  No

  N/A

• Do waste containers in food areas have tight fitting lids?

  Yes

  No

  N/A

• Is the area free of rodents, pests, and insects?

  Yes

  No

  N/A

• 5 in one poster, workers' comp, poster and safety rules placed in view?

  Yes

  No

  N/A

• Are the restrooms clean?

  Yes

  No

  N/A

• Are toilets and sinks operating properly?

  Yes

  No

  N/A

• Are restrooms adequately supplied with soap, towels, and toilet paper?

  Yes

  No

  N/A

• Are water fountains clean and working properly?

  Yes

  No

  N/A

• Is the work area kept clean and orderly?

  Yes

  No

  N/A

• Is the ventilation adequate?

  Yes

  No

  N/A

• Is the working environmental temperature within moderate range?

  Yes

  No

  N/A

• Is the break room area clean?

  Yes

  No

  N/A

• Are windows and doors in good repair and operational

  Yes

  No

  N/A

• Are locks on windows and doors in good repair and operational?

  Yes

  No

  N/A

• Are objects closer than 36' of the sprinkler heads?

  Yes

  No

  N/A

• Are objects closer than 36' of breaker boxes?

  Yes

  No

  N/A

• Are walls in good repair?

  Yes

  No

  N/A

• Are ceilings in good repair?

  Yes

  No

  N/A

• Are emergency telephone numbers posted near telephones?

  Yes

  No

  N/A

• Are emergency numbers posted near the first aid kit?

  Yes

  No

  N/A

• Are emergency evacuation plans posted?

  Yes

  No

  N/A

• Are emergency evacuation plans rehearsed within the last three months?

  Yes

  No

  N/A

• When:

  Date

• Are safety rules and practiced posted at this location?

  Yes

  No

  N/A

Walking & Working Surfaces

• Are the floors clean?

  Yes

  No

  N/A

• Are the floors dry?

  Yes

  No

  N/A

• Are the carpets clean?

  Yes

  No

  N/A

• Are floors free of scatter rugs?

  Yes

  No

  N/A

• Do aisles and hallways have adequate clearances?

  Yes

  No

  N/A

• Do aisles and hallways free of foreign objects?

  Yes

  No

  N/A

• Are all items, merchandise and storage kept out of aisles?

  Yes

  No

  N/A

• Are all item, merchandise and storage kept out of walkways?

  Yes

  No

  N/A

• Are all items, merchandise and storage kept out of hallways?

  Yes

  No

  N/A

• Is there adequate lighting for workers/participants/others?

  Yes

  No

  N/A

• Are storage areas maintained so items will not fall, slide or collapse?

  Yes

  No

  N/A

• Are the aisles maintained at a minimum width of 44" for stationary fixtures?

  Yes

  No

  N/A

• Are aisles maintained to a minimum width of 36" for moveable fixtures?

  Yes

  No

  N/A

• Are storage areas maintained so that items will not fall, slide or collapse?

  Yes

  No

  N/A

• Are walkways and parking lots clear of foreign debris?

  Yes

  No

  N/A

• Are bushes or trees obstructing any pathways?

  Yes

  No

  N/A

Exits & Entrances

• Do all work areas have two exit doors?

  Yes

  No

  N/A

• Does one exit lead directly outside of the building?

  Yes

  No

  N/A

• Are exits and aisles to exits kept clear at all times?

  Yes

  No

  N/A

• Emergency exits are free from obstructions?

  Yes

  No

  N/A

• Electrical switch panels are free from obstructions?

  Yes

  No

  N/A

• Fire extinguishers are free from obstructions?

  Yes

  No

  N/A

• Are exit signs working?

  Yes

  No

  N/A

• Do exit doors swing in the direction of the exit?

  Yes

  No

  N/A

• Are non-exit doors that could be confused with exit doors marked as "Not An Exit"?

  Yes

  No

  N/A

• Are exit signs distinctive in color relative to their background?

  Yes

  No

  N/A

• Are exits and exit signs free of decorations, draperies or furnishings?

  Yes

  No

  N/A

• When questioned, did staff member(s) know where the nearest exit was located?

  Yes

  No

  N/A

Fire Extinguishers and Fire Control

• Does the fire extinguisher appear to be in operable condition?

  Yes

  No

  N/A

• Fully charged as evidenced by gauge?

  Yes

  No

  N/A

• Safety seal in place?

  Yes

  No

  N/A

• Fire extinguishers are checked monthly?

  Yes

  No

  N/A

• Conveniently located?

  Yes

  No

  N/A

• Tag dated within the past twelve (12) months?

  Yes

  No

  N/A

• Are extinguisher kept in their proper place at all times when not in use?

  Yes

  No

  N/A

• Are extinguishers conspicuously located and marked?

  Yes

  No

  N/A

• If blocked from view, does a sign or arrow point to the extinguisher?

  Yes

  No

  N/A

• Are all extinguishers accessible in case of fire?

  Yes

  No

  N/A

• Are all extinguishers inspected monthly by GISONT staff as verified by the extinguisher inspection tag?

  Yes

  No

  N/A

• Has the sprinkler system been checked by the sprinkler contractor within the past fifteen (15) months?

  Yes

  No

  N/A

• Are flashlights or alternative lighting sources available?

  Yes

  No

  N/A

• Are emergency evacuation plans/routes posted on each level and positioned correctly?

  Yes

  No

  N/A

• When questioned, did staff member(s) know where the nearest fire alarm was located?

  Yes

  No

  N/A

• When questioned, did staff member(s) know what to do if they discover a fire?

  Yes

  No

  N/A

• When questioned, did staff member(s) know where the nearest fire extinguisher was located?

  Yes

  No

  N/A

Wiring

• Are electrical cords in good conditions (no fraying or cracking)?

  Yes

  No

  N/A

• Are lights adequately distributed?

  Yes

  No

  N/A

• Are lights working properly?

  Yes

  No

  N/A

• Are there an adequate number of electrical outlets available?

  Yes

  No

  N/A

• Are the outlets overloaded?

  Yes

  No

  N/A

• Are unused electrical outlets covered?

  Yes

  No

  N/A

• Are electrical outlets blocked?

  Yes

  No

  N/A

Storage

• Are materials securely stacked when stored?

  Yes

  No

  N/A

• Are chemicals properly stored and labeled?

  Yes

  No

  N/A

• Are Material Safety Data Sheets (MSDS) in the building?

  Yes

  No

  N/A

• Where is the MSDS information located?

• When questioned, did staff know where to locate the MSDS information?

  Yes

  No

  N/A

• When questioned, did staff know the purpose of the MSDS?

  Yes

  No

  N/A

Training, Protection and First Aid

• Does the location have a list of people trained in CPR, First Aid, and the use of fire extinguishers?

  Yes

  No

  N/A

• Is the information posted?

  Yes

  No

  N/A

• How many are trained in CPR?

• How many are trained in First Aid?

• How many are trained to use the fire extinguisher?

• Does the location have first aid supplies available?

  Yes

  No

  N/A

• Is the first aid kit/room readily available?

  Yes

  No

  N/A

• Is the first aid kit/room adequately maintained?

  Yes

  No

  N/A

• Are expiration dates on supplies current?

  Yes

  No

  N/A

• Where is the first aid kit/room located?

• When questioned, did staff member(s) know the location of the first aid kit/room?

  Yes

  No

  N/A

• Are first aid emergency procedures posted in eating areas?

  Yes

  No

  N/A

• Is employee emergency information readily available on all employees?

  Yes

  No

  N/A

Noted Discrepancies

• Any additional information/comments

• Signature of Inspector

  Sign