Title Page

  • Prepared by

  • Location
  • Conducted on

First Aid

  • Are first aid kits easy to find and accessible?

  • Are first aid kits undamaged and do they seem stocked?

Fire Safety

  • Are fire extinguishers easy to find and accessible?

  • Do fire extinguishers appear to be undamaged?

  • Check the small, round pressure gauge towards the top of the fire extinguisher: is the indicator in the green?

  • Are all walkways dry, clear, and free of clutter?

  • Are flammable/combustible materials stored away from walkways?

  • Are all doorways unobstructed?

Electrical Safety

  • Are breaker boxes easy to find and accessible?

  • Is the designated area around any breaker boxes kept clear?

  • Do plugs, cords, and outlets appear to be undamaged?

  • Is equipment plugged in safely and directly (i.e. No daisy-chaining or improper use of extension cords)?

  • Are doorways clear of cords?

Chemical/Hazardous Material and Equipment Safety

  • Are all chemicals labeled with either a manufacturer's label or a secondary container label?

  • Are chemicals kept closed and securely stored when not in use?

  • Are all emergency wash stations accessible?

  • Are emergency wash stations filled at least to fill line?

  • As applicable: do employees appear to be using appropriate PPE (personal protective equipment), such as helmets, earplugs, eye protection, foot protection, hand protection, etc?

  • As applicable: are appropriate equipment guards (finger guards, blade guards, etc.) intact and in use?

  • Do all employees appear to be using safe practices, i.e. handling equipment safely, safe lifting, ladder safety, etc.?

General

  • Is the area well lit and do all light fixtures appear to be in working order?

  • Are stairways clear of obstacles?

  • Are walkways wide enough (about 2.5ft minimum)?

  • Interview 3-5 employees about safety conditions. Example questions include (but are not limited to): Do you always feel safe in your work environment? What could be changed to make you feel safer at work? Do you know where the nearest fire extinguisher is located? Would you be able to use a fire extinguisher in the event of a fire? Where is the nearest exit? Where would you go in the event of an emergency?

  • Please make note of any additional questions, comments, or areas of concern here:

  • Please add any additional photos here:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.