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
Office
-
Floor
-
Hazard Class
-
Rugs (trip hazard)
-
Hazard Class
-
Furniture
-
Hazard Class
-
Kitchen
-
Hazard Class
-
AED System (green light)
-
Hazard Class
-
AED Battery Expiration Date (list date)
-
Hazard Class
-
AED Supply Contents (list inside)
-
Hazard Class
-
Conference Rooms (2)
-
Hazard Class
-
Training Room
-
Hazard Class
-
Washrooms
-
Hazard Class
-
Housekeeping (5S)
-
Hazard Class
-
Lighting
-
Hazard Class
Office Janitor's Closet
-
Housekeeping (5S)
-
Hazard Class
-
Lights
-
Hazard Class
-
MSDS Sheets
-
Hazard Class
Quality Assurance
-
Housekeeping (5S)
-
Hazard Class
-
Lights
-
Hazard Class
Warehouse/Materials
-
Housekeeping (5S)
-
Hazard Class
-
Lights
-
Hazard Class
-
Aisles
-
Hazard Class
-
Racking
-
Hazard Class
-
Stacking
-
Hazard Class
Production Lunchroom
-
Housekeeping (5S)
-
Hazard Class
-
Lights
-
Hazard Class
Maintenance PM Logs
-
Emergency Lighting (verify completion by maintenance)
-
Hazard Class
Fire Extinguishers
-
6
-
7
-
20
-
21
-
22
-
23
-
24
-
25
-
27
-
28
-
30
Comments
-
Addition Comments
-
Name & Initials