3. 
6. Facility Safety Inspection Checklist
8. Facility*
10. Inspected By*
11. Date
    Date
15. A. General Safety
17. 1. Check here if no problems found with General Safety
19. 1. Inadequate lighting provided in working areas
20. Comments
21. Picture
24. Corrective Action
25. Date Corrected
    Date Corrected
27. 1. Elevator(s) inspection certificate is not up to date
28. Comments
29. Picture
32. Corrective Action
33. Date Corrected
    Date Corrected
35. 1. Elevator(s) not functioning properly
36. Comments
37. Picture
40. Corrective Action
41. Date Corrected
    Date Corrected
43. 1. Work areas are not free of tripping hazards
44. Comments
45. Picture
48. Corrective Action
49. Date Corrected
    Date Corrected
51. 1. Furniture not in good and safe condition
52. Comments
53. Picture
56. Corrective Action
57. Date Corrected
    Date Corrected
59. 1. Overhead storage not used properly
60. Comments
61. Picture
64. Corrective Action
65. Date Corrected
    Date Corrected
67. 1. Not all objects are at least 18'' from sprinkler heads
68. Comments
69. Picture
72. Corrective Action
73. Date Corrected
    Date Corrected
75. 1. Basic First Aid supplies are not adequate
76. Comments
77. Picture
80. Corrective Action
81. Date Corrected
    Date Corrected
83. 1. MSDS are not available to all employees
84. Comments
85. Picture
88. Corrective Action
89. Date Corrected
    Date Corrected
93. B. Fire and Electrical Prevention and Safety
95. Date of most recent fire alarm test
    Date of most recent fire alarm test
96. Date of last fire drill
    Date of last fire drill
98. 1. Check here if no problems found with Fire and Electrical Prevention
100. 1. Portable fire extinguishers are not readily available
101. Comments
102. Picture
105. Corrective Action
106. Date Corrected
     Date Corrected
108. 1. Fire extinguishers are not mounted or identifiable
109. Comments
110. Picture
113. Corrective Action
114. Date Corrected
     Date Corrected
116. 1. Fire extinguishers are not inspected monthly
117. Comments
118. Picture
121. Corrective Action
122. Date Corrected
     Date Corrected
124. 1. Fire alarms are not functioning properly
125. Comments
126. Picture
129. Corrective Action
130. Date Corrected
     Date Corrected
132. 1. Fire drills are not conducted at regular intervals
133. Comments
134. Picture
137. Corrective Action
138. Date Corrected
     Date Corrected
140. 1. Damaged electrical and extension cords
141. Comments
142. Picture
145. Corrective Action
146. Date Corrected
     Date Corrected
148. Electrical Panels

     1. Electrical panels are not labeled properly
149. Comments
150. Picture
153. Corrective Action
154. Date Corrected
     Date Corrected
156. 1. Electrical closets are not free of storage
157. Comments
158. Picture
161. Corrective Action
162. Date Corrected
     Date Corrected
166. C. Egress
168. 1. Check here if no problems found with Egress
170. 1. Emergency exit doors are not functioning properly
171. Comments
172. Picture
175. Corrective Action
176. Date Corrected
     Date Corrected
178. 1. Emergency or exit lights are not working properly
179. Comments
180. Picture
183. Corrective Action
184. Date Corrected
     Date Corrected
186. 1. Hallways/stairways are not free of obstruction
187. Comments
188. Picture
191. Corrective Action
192. Date Corrected
     Date Corrected
194. 1. Stairways are not lighted with stair tread in place
195. Comments
196. Picture
199. Corrective Action
200. Date Corrected
     Date Corrected
204. D. Maintenance
206. 1. Check here if no problems found with Maintenance
208. 1. Doors or locks are not in good working order
209. Comments
210. Picture
213. Corrective Action
214. Date Corrected
     Date Corrected
216. 1. Visible weather damage/mold
217. Comments
218. Picture
221. Corrective Action
222. Date Corrected
     Date Corrected
224. 1. Not all windows are intact and free from damage
225. Comments
226. Picture
229. Corrective Action
230. Date Corrected
     Date Corrected
232. 1. Outside lights are not functioning properly
233. Comments
234. Picture
237. Corrective Action
238. Date Corrected
     Date Corrected
240. 1. Parking lot safety concerns
241. Comments
242. Picture
245. Corrective Action
246. Date Corrected
     Date Corrected
248. 1. Evacuation routes are not posted or visible
249. Comments
250. Picture
253. Corrective Action
254. Date Corrected
     Date Corrected
256. 1. Building exterior shows some safety concerns
257. Comments
258. Picture
261. Corrective Action
262. Date Corrected
     Date Corrected
268. H. Other concerns
Leave This Blank:


270. 1. Receive an email copy of this form.
271. Email address

     This field is not part of the form submission.

272. Submit

* indicates a required field