Safety Inspection (First Aid - Fire Extinguishers-AED-Eye Wash stations)

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

1.0 - Previous inspection

• 1.1 - Has the last inspection been reviewed?

  Yes

  No

  N/A

• 1.2 - Are there no outstanding actions?

  Yes

  No

  N/A

2.0 - Fire Prevention

• 2.3 - Extinguishers in place, clearly marked for type of fire?

  Yes

  No

  N/A

• 2.4 - Extinguishers recently serviced? (Check 6 monthly punch mark on tabs.)

  Yes

  No

  N/A

• 2.5 - Extinguishers clear of obstructions?

  Yes

  No

  N/A

Automated External Defibrillator ( AED)

• Is cabinet in good condition- GPS location sticker is in place- Has inspection tag

  Yes

  No

  N/A

• Is unit clean- Has no visible damage- status indicator is green

  Yes

  No

  N/A

• Voice Prompt activates when lid is opened

  Yes

  No

  N/A

• Instruction manual and CD are in unit

  Yes

  No

  N/A

• Battery is fully charged- connections are clean- undamaged (alarm will sound after date)

  Yes

  No

  N/A

• Electrodes are within expiration date-sealed-clean-in good condition

  Yes

  No

  N/A

• Ready kit is attached- all items in kit- items within expiration date

  Yes

  No

  N/A

• Ready kit inventory: 2- 4x4 gauze pads, 2- antiseptic towelettes, 1-pair large vinyl gloves, 1-pair medium vinyl gloves, 1- CPR mouth barrier, 1- razor

  Yes

  No

  N/A

• Status indicator returns to green after lid is closed.

  Yes

  No

  N/A

Yellow eye wash station

• Is eye wash station in good condition? Is it easily accessible?

  Yes

  No

  N/A

• Is eye wash fluid within expiration date?

  Yes

  No

  N/A

• Is check off tag in good condition and has it been updated?

  Yes

  No

  N/A

• Is eyewash station seal unbroken?

  Yes

  No

  N/A

Green Eye Wash Stations

• Are eye wash stations easily accessible?

  Yes

  No

  N/A

• Is eye wash within the expiration date?

  Yes

  No

  N/A

• Are bottles in good condition with seals unbroken?

  Yes

  No

  N/A

12.0 - First Aid Facilities

• 12.1 - Are cabinets and contents clean and orderly?

  Yes

  No

  N/A

• 12.2 - Are contents complete?

  Yes

  No

  N/A

• 12.3 - Are contents within expiration date?

  Yes

  No

  N/A

• 12.4 - Cabinets clearly labelled?

  Yes

  No

  N/A

• 12.5 - Is there easy access to cabinets?

  Yes

  No

  N/A

Sign Off

• On site representative

  Sign

• Auditor's signature

  Sign