Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
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Emergency contact information posted
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Forklifts are equipped with backup alarms
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Mirrors installed at blind spots
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Sprinkler valves locked open or equipped with tamper switches
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Electrical outlets adequate (no overloads or unapproved extension cords in use)
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Electrical and extension cords used to connect equipment undamaged
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Electrical panels labeled properly and free of defects
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Carpeted floors clean and are there no areas where there are loose carpet, rips or bumps (Indicate specific carpeting concerns and their locations in the "Comments" section below)
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All carpeted areas free of safety concerns, such as tripping hazards
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Uncarpeted floors clean, slip-resistant, in good repair with treads in place (Indicate specific flooring concerns and their locations in the "Comments" section below)
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Anti slip mats and flooring used where appropriate
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Portable ladders equipped with non-slip feet
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Elevated areas have guardrails and toe boards
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Stairways in good repair with handrails, treads and risers in proper proportion and are non-slip
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Devices or alarms, which were installed to restrict the improper use of an exit, installed and functioning so that they cannot impede emergency use of such exit
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All emergency exit doors functioning properly
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Emergency and exit lights in working order
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Doors arranged to be readily opened from the egress side whenever the building is occupied
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All exits marked by a readily visible sign with letters at least six inches high and three-fourth inches wide
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Where exits are not readily visible, accesses to the exits are marked by readily visible signs
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Means of egress (i.e. hallways and stairways) maintained free of all obstructions or impediments
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Stairways are well lighted, handrails in good condition and stair treads in place
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Closed stairways provided with a railing on at least one side
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Doors and locks in good working order<br>
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Ceiling tiles intact, undamaged and in place
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No signs of weather damage or mold growth in the facility
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Windows unbroken and free from any type of damage
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Air conditioning vents and ducts appear to be clean upon visual inspection
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Outside lights in good working order
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Exterior of the building presents no safety concern
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Parking lot free of safety concerns (i.e. overgrown landscaping, uneven pavement, traffic hazards)
Signature
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Any other comments?
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When completed please provide signature here: