Title Page

  • Department
  • Conducted on

  • Prepared by:

  • Location:
  • Personnel

Safety Management

  • Are hand rails solidly mounted (not loose)?

  • Is location free from trip hazards?

  • Are walls free from paint or repair needs?

  • Are any cables or wires not exposed?

  • Are oxygen cylinders stored correctly? Empty and full containers physically separated? Open cylinders not stored with full?

  • Are compressed gas cylinders stored and secured properly? Compressed gas cylinders need to be chained to the wall or on a cart secured. Freestanding cylinders are not allowed.

  • Are ceiling tiles clean, stain free, and in good condition? Indicate location of bad tiles in notes section.

  • Are nurse call pull cords proper length - 2 to 6 inches from floor, not tied to grab bars, etc.?

  • Are the total number of oxygen tanks within the allowable limits? No greater than 12 in a smoke compartment outside of storage rooms.

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.