Information

  • Month/Year

  • Prepared by

  • Conducted on

  • Hazard Classification:
    Class (A) - Major - To be corrected Immediately
    A condition or practice likely to cause permanent disability, loss of life or body and/or extensive loss of structure, equipment or material

  • Class (B) - Serious - To be corrected within 24 hours
    A condition or practice likely to cause injury or illness, resulting in temporary disability or property damage that is disruptive but not excessive

  • Class (C) - Minor - To be placed on action plan
    A condition or practice likely to cause minor, non-disabling injury or illness or non-disruptive property damage

Hazardous Waste Storage

  • Housekeeping (5S)

  • Hazard Class

  • Lighting

  • Hazard Class

  • Liquids (labeled & properly stored)

  • Hazard Class

First Aid Room

  • Housekeeping (5S)

  • Hazard Class

  • Lights

  • Hazard Class

  • Emergency Contact List Available

  • Hazard Class

  • Incident Report Forms Available

  • Hazard Class

  • Record Log (maintained?)

  • Hazard Class

  • AED System (green light)

  • Hazard Class

  • AED Battery Expiration Date (list date)

  • Hazard Class

  • AED Supply Contents (list)

  • Hazard Class

Production Washrooms

  • Housekeeping (5S)

  • Hazard Class

  • Lights

  • Hazard Class

  • Supplies

  • Hazard Class

Production Janitor's Closet

  • Housekeeping (5S)

  • Hazard Class

  • Lights

  • Hazard Class

Fire Extinguishers

  • 11

  • 12

  • 13

  • 14

  • 15

  • 17

  • 18

  • 19

  • 31

Comments

  • Addition Comments

  • Name & Initials

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.