Title Page
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Document No.
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Audit Title
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Inspection Date/Time
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Inspectors
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Inspection Areas:
Area 1: A/B 200, A/B 300, A/B/C Junction 400, A/B 500
Area 2: C200 (Library workroom), C/CH/D 300, C/D 400
Area 3: E100 (basic: lobby; thorough: lobby and studio), E/F 200, E/F 300, E/F 400
Area 4: G200, G300, G400 (plus CH100 - basement & mechanical room - during thorough)
Area 5: CH200 (includes kitchen & serving areas), External, L700 Attic during thorough -
Please indicate inspection area:
Item 1
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Location
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Hazard Observed
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Hazard Class
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Picture of the hazzard
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Repeat?
Item 2
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Location
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Hazard Observed
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Hazard Class
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Picture of the hazzard
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Repeat?
Item 3
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Location
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Hazard Observed
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Hazard Class
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Picture of the hazzard
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Repeat?
Item 4
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Location
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Hazard Observed
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Hazard Class
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Picture of the hazzard
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Repeat?
Item 5
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Location
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Hazard Observed
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Hazard Class
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Picture of the hazzard
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Repeat?
Item 6
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Location
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Hazard Observed
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Hazard Class
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Picture of the hazzard
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Repeat?
Item 7
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Location
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Hazard Observed
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Hazard Class
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Picture of the hazzard
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Repeat?
Item 8
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Location
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Hazard Observed
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Hazard Class
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Picture of the hazzard
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Repeat?
Final Comments
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Comments
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JHSC Signature #1
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JHSC Signature #2
