Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

Contamination and Irregularities (Indoor Walking and Working Surfaces)

  • Do tiles, linoleum, or other flooring have holes, cracks, or bumps?

  • Is carpeting buckled, loose, or frayed?

  • Are carpet edges curled up?

  • Does floor feel greasy or slippery?

  • Are liquid contaminants present (water, grease, oil, cleaning solutions, coffee, body fluids)?

  • Are dry contaminants present (powder, sawdust, dirt, flour, food, wax chips)?

  • Are there sudden changes in indoor floor elevation > 1/4"?

  • Are there metal grates or mesh flooring in the walkway?

  • Are water absorbent walk-off mats used in entrances?

  • Are slip-resistant mats used in wet areas?

Contamination and Irregularities (Outdoor Walking and Working Surfaces)

  • Are there gaps, cracks, or holes in the outdoor walkway > 1/2"

  • Are there metal grates or mesh flooring in the walkway?

  • Is the walkway uneven, with abrupt changes in level > 1/2"?

  • Is there debris (pebbles, rocks, leaves, grass clippings) on the walkway?

  • Are there any slippery conditions present (water, grease, ice, snow)?

  • Are concrete wheel stops in the parking areas highlighted with paint?

Drainage: Pipes and Drains

  • Are drains clogged or filled with debris?

  • Are pipes splashing water onto a walking surface?

  • Are outside drain pipes or down spouts spilling water on walkways?

  • Are pipes properly aligned with drains inside and outside of the facility?

Weather Conditions (Ice and Snow)

  • Are bins containing ice melting chemicals and scoops provided at areas of heavy pedestrian traffic?

  • Are ice-melting chemicals swept up once walkways are dry?

  • Is winter weather communications distribution system in place?

  • Is snow removal appropriately scheduled?

Stairs and Handrails

  • Are all handrails 34-38" from the floor?

  • Are handrails provided on slopes, ramps, stairs?

  • Do handrails extend at least as far as the last step?

  • Are handrails provided at steps (employee shuttle bus stop, entrances, conference and training rooms)?

  • Are the edges/noses of each step painted or marked?

  • Are stairway risers and steps all of uniform size?

Tripping Hazards (Clutter, Loose Cords, Hoses, Wires, and Medical Tubing)?

  • Are cords bundled using a cord organizer?

  • Are cords on the floor covered with a beveled protective cover or tape?

  • Are cords mounted under the desk or on equipment?

  • Are hallways, stairs, and walkways clear of clutter (boxes, cords, equipment)?

  • Is there appropriate storage (closet, shelves, hooks, lockers)?

  • Are stepstools available for use in areas with overhead storage?

  • Do rolling office chairs have a sturdy base (no less than 5 legs)?

Lighting (Indoors and Outdoors)

  • Are light bulbs burned out?

  • Are any areas dim, poorly lit, or shadowy?

  • Are lighting levels compliant with local codes, ANSI, and/or Illuminating Engineering Society (IESNA) recommendations?


  • Do mats have abrupt squared-off edges, lacking a bevel?

  • Are mat edges curled up or flipped over?

  • Do mats slide around on the floor?

Slip-Resistant Shoes

  • Are employees wearing slip-resistant shoes (safety shoe marked as slip-resistant)?

  • Do shoe soles have worn-down tread?

  • Is the shoe sole tread clogged with dirt, food, debris, or snow?

  • Are employees that must work outside wearing slip-resistant footwear?

Visual Cues

  • Are changes in walkway elevation highlighted?

  • Are curbs highlighted?

  • Are highly visible wet floor signs available and used correctly?

  • Are barriers available and used to prevent access into wet or dangerous areas?

  • Are wet floor signs removed promptly once floor is dry/clean?

Safety Products

  • Are the following products available and conveniently located throughout the facility?

  • Wall-mounted spill absorbent pads or paper towels?

  • Cups near water fountains?

  • Trash cans?

  • Pop-up tent floor signs?

  • Umbrella bags?

  • Barrier and access restriction devices?

Employee Communication

  • Do all employees know the contact number for the housekeeping department?

  • Are winter weather warnings distributed to staff through email?

  • Are all employees aware of the housekeeping procedures?

  • Do employees know where safety products are stored?

  • Are cleaning methods for all floors and paths recorded and displayed?

  • Are employees that use ladders trained in safe ladder use and maintenance?

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.