RBC Safety Inspection - Simplified

• Safety Inspection
  
  This form is designed to assist safety coordinators to perform effective safety inspections. Please review conditions. If possible correct any unsafe conditions while performing the investigation. Any pending items should be corrected promptly.

• Area Inspected

• Location
  Address

• Date

  Date

• Coordinator:

  Sign

• Assisted By:

  Sign

1. Volunteer Habits and Actions

• Add an issue

Incident

• Specific Location

• Describe Unsafe Condition and Recommended Solution

• Date

  Date

• Initials

2. Lockout/Tagout

• Add an issue

Incident

• Specific Location

• Describe Unsafe Condition and Recommended Solution

• Date

  Date

• Initials

3. Personal Protective Equipment

• Add an issue

Incident

• Specific Location

• Describe Unsafe Condition and Recommended Solution

• Date

  Date

• Initials

4. Equipment Safeguards

• Add an issue

Incident

• Specific Location

• Describe Unsafe Condition and Recommended Solution

• Date

  Date

• Initials

5. Hand and Power Tools

• Add an issue

Incident

• Specific Location

• Describe Unsafe Condition and Recommended Solution

• Date

  Date

• Initials

6. Heavy Equipment/Materials Handling

• Add an issue

Incident

• Specific Location

• Describe Unsafe Condition and Recommended Solution

• Date

  Date

• Initials

7. Ergonomics

• Add an issue

Incident

• Specific Location

• Describe Unsafe Condition and Recommended Solution

• Date

  Date

• Initials

8. Personal Safety/Passersby Hazards

• Add an issue

Incident

• Specific Location

• Describe Unsafe Condition and Recommended Solution

• Date

  Date

• Initials

9. Hazards (chemical, electrical, environmental, fire, etc.)

• Add an issue

Incident

• Specific Location

• Describe Unsafe Condition and Recommended Solution

• Date

  Date

• Initials

10. Emergency Response

• Add an issue

Incident

• Specific Location

• Describe Unsafe Condition and Recommended Solution

• Date

  Date

• Initials

11. Fall Prevention

• Add an issue

Incident

• Specific Location

• Describe Unsafe Condition and Recommended Solution

• Date

  Date

• Initials

12. Ladders

• Add an issue

Incident

• Specific Location

• Describe Unsafe Condition and Recommended Solution

• Date

  Date

• Initials

13. Housekeeping/Storage Methods

• Add an issue

Incident

• Specific Location

• Describe Unsafe Condition and Recommended Solution

• Date

  Date

• Initials

14. Building Integrity

• Add an issue

Incident

• Specific Location

• Describe Unsafe Condition and Recommended Solution

• Date

  Date

• Initials

Sign Off

• Coordinator:

  Sign

• Assisted By:

  Sign