• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Sprinkler System

  • Control Valves open and scaled?

  • Monthly 2" drain test conducted?

  • Alarm or water going fully operational on 2" drain test?

  • A clear space of 5' is maintained in front of the sprinkler riser?

  • Outside fire department hookup is not blocked?

  • Protective covers in place on fire department hookup?

Forklift & Delivery Truck

  • Each piece is equipped with a back up alarm?

  • Drivers trained and properly licensed?

  • Fuel tanks properly secured on forklifts?

  • Glass on trucks in good repair?

  • All lights and signals operating?

  • Seats and seat belts in good repair?

  • Rubber pads on break & clutch pedals do not show excessive wear?

  • Horn working?

  • Tires in good repair?

  • No mechanical repairs needed?

  • Load straps in good condition?

  • Verify truck annual inspection is current?

  • Pallet jacks, dollies, drywall carts in good condition?

Parking Lots & Outside Storage Areas

  • Parking lots, yard areas, & sidewalks free from snow ice and sanded/salted?

  • Entrances & exits are clear of material, snow, ice, and maintained dry?

  • No hazardous areas in parking lots or walkways (potholes or broken asphalt)?

  • Fire lanes clearly marked & unobstructed?

  • Dumpsters located a minimum of 25' from hydrants?

  • Adequate lighting?

  • Material stored in a safe manner?

  • Good housekeeping practices?

Electrical Systems

  • No burnt out light fixtures or buzzing ballast in need of replacement?

  • No broken or loose electrical conduit?

  • A clear space of 3' is maintained in front of electrical panel boxes?

  • No missing knockout plugs or junction box covers?

  • Electrical panel doors are maintained in the closed position at all times?

  • Electrical cords free of cracks & splices?

  • Extension cords free of cracks & splices?

  • No multi-plugs utilized in outlets?

  • Conduit, junction & panel boxes, outlets & monitors are free of dust and oil?

  • Ensure the electrical service panel is properly grounded?

  • Electrical panels properly labeled and marked?


  • Electrical in 4 satisfactory?

  • Smoking prohibited or confined to designated areas with receptacles provided?

  • Floors are free of cigarette butts, trash, & tripping hazards?

  • Pressurized cylinders secured in a rack or chained to a fixed object?

  • Floor area free of scrap lumber, packing material, & other tripping hazards?

  • All fluid leaks cleaned up immediately?

  • Exit marked & unobstructed?

  • Fire extinguishers clearly marked, accessible, fully charged, & annually serviced?

  • Class A fire extinguishers are accessible within 75' or less?

  • Class B fire extinguishers are accessible within 50' or less?

  • Housekeeping in excellent order?

  • Employees wearing proper protective equipment?

  • Hard Hat?

  • Steel/Composite Toe Boots?

  • Hearing Protection?

  • Eye Protection?

  • An 18" clear space is maintained below the sprinkler heads?

  • Posted load limits for deck & shelving?

Employee Observation/ Safe & Unsafe Acts Observed:

  • Comments:

Office, Storage, Display, Restroom, & Break Areas

  • Electrical in 4 are satisfactory?

  • Smoking prohibited or confined to designated areas with proper receptacles?

  • Floors are free of cigarette butts, trash, & tripping hazards?

  • Lunch areas & rest rooms are clean?

  • First aid kits are fully supplied?

  • Exits properly marked & unobstructed?

  • An 18" clear space is maintained below the sprinkler heads?

  • Emergency lighting with battery backup operates properly when test button is depressed?

  • Names of employees certified in first aid, CPR, & annually trained in blood borne pathogen with names posted on first aid kits?

  • Fire extinguishers clearly marked, accessible, fully charged, annually serviced, & accessible within 75' or less?

  • Hallways & storage rooms have clear pathways & aisles free of debis?

  • Step stools & small ladders available for reaching bookshelves?

  • Easy access to storage room boxes & supplies?

  • Emergency telephone numbers posted where all employees have access?

  • Emergency Evacuation Plan & Accident Procedures posted?

  • OSHA poster and other required legal posters where employees have access?

  • Emergency lighting with battery back up

  • Sidewalks and parking lots free of ice and snow in winter?

Office Ergonomics


  • Adjusted correctly to achieve correct posture - 90 degree angle at hips and knees, feet resting flat and comfortably on the floor or foot rest?

  • Forearms, wrists, &hands in straight line while using keyboard?

  • Ample clearance to move legs under the desktop, workstation, or keyboard tray?

  • Chair provides some clearance behind knees when seated against the backrest?


  • Directly in front of the employee while at the keyboard?

  • Top of monitor at or just below eye level?

  • Positioned an arm's length away?

  • Reflection/glare on the screen is minimized either by tilting monitor or using ant-glare filter?

  • Document holder used to place materials as close to the monitor as possible, and at the same distance & height?

  • Employee knows how to adjust monitor's brightness and contrast to a comfortable level?

  • Computer screen is clear?


  • Overhead lighting does not cause glare on work surfaces?

  • Task lighting is used to illuminate work surfaces?

  • Glare on work surfaces is reduced through the use of window shades, blinds, or anti-glare filter on computer screen?


  • Frequently used items or materials are within easy reach?

  • Temperature in the work area is maintained at a comfortable level?

  • Employee takes frequent breaks to allow joints and muscles to rest?

  • Noise levels in work area are at a comfortable and non-distracting level?

  • Comments:

  • Safety Officer

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.