Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

  • Emergency contact information posted

  • Forklifts are equipped with backup alarms

  • Mirrors installed at blind spots

  • Sprinkler valves locked open or equipped with tamper switches

  • Electrical outlets adequate (no overloads or unapproved extension cords in use)

  • Electrical and extension cords used to connect equipment undamaged

  • Electrical panels labeled properly and free of defects

  • 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)

  • All carpeted areas free of safety concerns, such as tripping hazards

  • Uncarpeted floors clean, slip-resistant, in good repair with treads in place (Indicate specific flooring concerns and their locations in the "Comments" section below)

  • Anti slip mats and flooring used where appropriate

  • Portable ladders equipped with non-slip feet

  • Elevated areas have guardrails and toe boards

  • Stairways in good repair with handrails, treads and risers in proper proportion and are non-slip

  • 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

  • All emergency exit doors functioning properly

  • Emergency and exit lights in working order

  • Doors arranged to be readily opened from the egress side whenever the building is occupied

  • All exits marked by a readily visible sign with letters at least six inches high and three-fourth inches wide

  • Where exits are not readily visible, accesses to the exits are marked by readily visible signs

  • Means of egress (i.e. hallways and stairways) maintained free of all obstructions or impediments

  • Stairways are well lighted, handrails in good condition and stair treads in place

  • Closed stairways provided with a railing on at least one side

  • Doors and locks in good working order<br>

  • Ceiling tiles intact, undamaged and in place

  • No signs of weather damage or mold growth in the facility

  • Windows unbroken and free from any type of damage

  • Air conditioning vents and ducts appear to be clean upon visual inspection

  • Outside lights in good working order

  • Exterior of the building presents no safety concern

  • Parking lot free of safety concerns (i.e. overgrown landscaping, uneven pavement, traffic hazards)

Signature

  • Any other comments?

  • When completed please provide signature here:

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.