Information
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Month/Year
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Prepared by
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Conducted on
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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
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Housekeeping (5S)
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Hazard Class
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Lighting
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Hazard Class
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Liquids (labeled & properly stored)
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Hazard Class
First Aid Room
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Housekeeping (5S)
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Hazard Class
-
Lights
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Hazard Class
-
Emergency Contact List Available
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Hazard Class
-
Incident Report Forms Available
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Hazard Class
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Record Log (maintained?)
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Hazard Class
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AED System (green light)
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Hazard Class
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AED Battery Expiration Date (list date)
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Hazard Class
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AED Supply Contents (list)
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Hazard Class
Production Washrooms
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Housekeeping (5S)
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Hazard Class
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Lights
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Hazard Class
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Supplies
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Hazard Class
Production Janitor's Closet
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Housekeeping (5S)
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Hazard Class
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Lights
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Hazard Class
Fire Extinguishers
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11
-
12
-
13
-
14
-
15
-
17
-
18
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19
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31
Comments
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Addition Comments
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Name & Initials
