Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
WALK AROUND OF FACILITY / PROPERTY
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Are there any violations?
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Violations Discovered
Violation
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Location of Violation
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Photographic Evidence
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Description of Violation
PREVIOUS UNCORRECTED VIOLATIONS
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Are there any uncorrected violations from a previous inspection?
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Uncorrected Violations
Violation
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Location of Violation
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Photographic Evidence
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Description of Violation
RECEIPT
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This safety inspection is used to determine your compliance with the Occupational Safety and Health Administration (OSHA) standards and practices. Any violations discovered may be utilized to help determine the areas of concern that need addressing.
Your signature for receipt of this report acknowledges your understanding that if any violations are discovered they will be corrected as soon as possible. You also understand that by failing to correct any violations discovered, you will be held liable for any violations that may be discovered during a safety inspection from OSHA or your State Enforcement Agency.
You also agree not to hold Employer Advantage and/or its representative liable for any violations discovered during a safety inspection conducted by any investigator or enforcement officer.
Refusing to sign this report does not in any way release you from any liability. -
Assessor
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Company Representative
