University General Safety Inspection

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

BASIC SAFETY

• Visual Insight

  Media

• Overall appearance of area

  Safe

  At Risk

  N/A

• Area lighting

  Safe

  At Risk

  N/A

• Railing

  Safe

  At Risk

  N/A

• Guarding

  Safe

  At Risk

  N/A

• Path of egress

  Safe

  At Risk

  N/A

• Slip Trip Fall hazards

  Safe

  At Risk

  N/A

• Clutter

  Safe

  At Risk

  N/A

• Equipment storage

  Safe

  At Risk

  N/A

SECURITY

• Visual Insight

  Media

• Access secured

  Yes

  No

  N/A

• Area(s) properly identified

  Yes

  No

  N/A

• Rooms properly secured<br>(doors not propped open, door locks working properly, etc.)

  Yes

  No

  N/A

CHEMICAL MANAGEMENT

• Visual Insight

  Media

• Chemicals properly stored

  Yes

  No

  N/A

• Proper labels

  Yes

  No

  N/A

• Proper waste storage

  Yes

  No

  N/A

PERSONAL PROTECTIVE EQUIPMENT

• Visual Insight

  Media

• Employees using PPE

  Yes

  No

  N/A

• Proper PPE available

  Yes

  No

  N/A

FIRE and LIFE SAFETY

• Visual Insight

  Media

• Fire extinguisher available

  Yes

  No

  N/A

• Proper access to fire extinguisher

  Yes

  No

  N/A

• Proper storage of combustible material

  Yes

  No

  N/A

EHS PROGRAM USE

• Is there any regulated work taking place (confined space, hot work, high elevation work, etc)

  Yes

  No

  N/A

• If yes to above, identify below

• Does it appear proper procedures and rules are being followed

  Yes

  No

  N/A

OTHER AREAS OF CONCERN

• Visual Insight

  Media

• Other areas of Environmental Health and Safety concerns have been witnessed as described

EHS FOLLOW UP

• The Department of Safety will conduct a follow up inspection if conditions warrant such. Follow up inspections will be completed within the specified time listed, following the date of this report.

  24 hours

  3days

  7 days

  30 days

  No Follow Up Necessary

SIGNATURE OF INSPECTION COMPLETION

• Overall rating of area inspected

• Reasoning for Rating

• Staff Member Completing Inspection

  Sign

• Staff Member Completing Inspection

  Sign

• Date of Completion

  Date