Toll Booth Facility - Safety Inspection

• Location
  Address

• Conducted on

  Date

• Inspector

• Inspection Type

RESTROOMS: (Public & Employee restrooms)

• 1. Counter Tops

  Yes

  No

  N/A

• 2. Sinks

  Yes

  No

  N/A

• 3. Toilets/Urinals

  Yes

  No

  N/A

• 4. Toilets Paper Dispensers

  Yes

  No

  N/A

• 5. Toilet Partitions

  Yes

  No

  N/A

• 6. Floors

  Yes

  No

  N/A

• 7. Ceiling/Windows/Walls

  Yes

  No

  N/A

• 8. Hand Dryers

  Yes

  No

  N/A

• 9. Trash Receptacle

  Yes

  No

  N/A

• 10. Soap Dispensers

  Yes

  No

  N/A

• 11. Changing Table

  Yes

  No

  N/A

• 12. Mirrors

  Yes

  No

  N/A

• 13. LIghts Interior

  Yes

  No

  N/A

BUILDINGS: Main Building & Toll Booths

• 1. Roofs/Fascia/Soffits

  Yes

  No

  N/A

• 2. Gutters/Down Spouts

  Yes

  No

  N/A

• 3. Exterior Walls/Windows/Ceilings

  Yes

  No

  N/A

• 4. Doors

  Yes

  No

  N/A

• 5. Foyers/Floors/Lights

  Yes

  No

  N/A

• 6. Handrails

  Yes

  No

  N/A

• 7. Exterior Building Lights

  Yes

  No

  N/A

• 9. Utility Area

  Yes

  No

  N/A

• 10. Fire Extinguisher

  Yes

  No

  N/A

• 11. Generators

  Yes

  No

  N/A

• 12. Signs

  Yes

  No

  N/A

• 13. Accessibility

  Yes

  No

  N/A

• 14. Air Conditioner/Ventilation

  Yes

  No

  N/A

ROADWAY: (Factor=10)

• 1. Pavement Condition

  Yes

  No

  N/A

• 2. Highway Lighting

  Yes

  No

  N/A

• 3. Signs

  Yes

  No

  N/A

• 4. Object Markers/Delineators

  Yes

  No

  N/A

• 5. Striping/Symbols/RPM's

  Yes

  No

  N/A

• 6. Shoulders/Slopes

  Yes

  No

  N/A

• 7. Sweeping

  Yes

  No

  N/A

• 8. Guardrail

  Yes

  No

  N/A

• 9. Drainage

  Yes

  No

  N/A

Toll Booths

• Number of lanes closed. Are traffic cones in proper location?

• Safety chains or barrier in place between high speed lanes and walkway?

• Booth attendant in uniform

  Yes

  No

  N/A

• Safety barriers in place. Yellow pillars, concrete wall, etc.

  Yes

  No

  N/A

• Toll booth doors able to close properly?

  Yes

  No

  N/A

• Walkway clear and marked

  Yes

  No

  N/A

GROUNDS: (Factor=20)

• 1. Turf Condition

  Yes

  No

  N/A

• 2. Vegetation/Landscaping

  Yes

  No

  N/A

• 3. Litter

  Yes

  No

  N/A

• 4. Trash Receptacles

  Yes

  No

  N/A

• 5. Recycle Receptacles

  Yes

  No

  N/A

• 6. Lights Exterior

  Yes

  No

  N/A

• 7. Sidewalks

  Yes

  No

  N/A

• 8. Edging and Trimming

  Yes

  No

  N/A

• 9. Trees

  Yes

  No

  N/A

• 10. Flags

  Yes

  No

  N/A

• 11. Picnic or Parking Area

  Yes

  No

  N/A

• 12. Tripping Hazards

  Yes

  No

  N/A

• 13. Pest / Insect Control

  Yes

  No

  N/A

• 14. Fences

  Yes

  No

  N/A

EMPLOYEE/CUSTOMER SERVICES:

• 1. Bulletin Boards

  Yes

  No

  N/A

• 2. Break Room available and clean

  Select Yes No N/A

  • Yes
  • No
  • N/A

Main Office:

• Person Available

  Yes

  No

  N/A

• Supplies and Equipment Properly Stored

  Yes

  No

  N/A

• Fire Extinguishers - inspected and current

  Yes

  No

  N/A

• First Aid Kit - inspected and current

  Yes

  No

  N/A

• MSDS book

  Yes

  No

  N/A

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