General Safety Inspection Form
Survey notes on reverse page. GOOD POOR
TRIP/SLIP/FALL HAZARDS
- Area is free of trip/fall/slip hazards (carpets, holes, obstacles). _______ _______
- Area is free of loose wires, computer cables and telephone cords. _______ _______
- Area is free of standing liquids. _______ _______
FIRST AID KITS
- Kit contains only bandages, gauze, tape etc. (No oral or topical medications. Refer to
Policy SY-21 for more information.) _______ _______
- Is/are readily accessible. _______ _______
- Signs identify location of kit. _______ _______
LOADING DOCKS
- Pallets are not stacked on end. _______ _______
- Compressed gas cylinders are properly secured. _______ _______
_____________________________________________________________________________________
FIRE DOORS
- Should be closed at all times. _______ _______
MEANS OF EGRESS
- Exit signs are present and illuminated. _______ _______
- Exits, floors, hallways and aisles are unobstructed. _______ _______
- Stairwells/corridors are not used for storage/free of furniture, equipment. _______ _______
- Lighting is operable for all means of egress. _______ _______
- Bicycles are not present indoors. _______ _______
HOUSEKEEPING
- No excess storage of combustibles (boxes, papers, files etc.) is present. _______ _______
FIRE EXTINGUISHERS
- Last inspection is within 12 months. _______ _______
- Extinguisher is mounted to the wall. _______ _______
- Extinguisher is in open view and accessible. _______ _______
FIRE ALARM DEVICES
- Pull stations are visible and unobstructed. _______ _______
____________________________________________________________________________________
WIRING
- Wiring is not frayed or altered. _______ _______
- Outlets do not possess more than one multiplug adapter. _______ _______
- Outlet faceplates are present and intact. _______ _______
- Switch faceplates are present and intact. _______ _______
- Cords and plugs are not altered. _______ _______
- Cords are not running under carpets, desk legs, walkways etc. _______ _______
ELECTRICAL PANELS
- Panel covers are present. _______ _______
- Panels are visible and readily accessible (3 feet clear floorspace). _______ _______
_____________________________________________________________________________________
MACHINE GUARDING
- All pinchpoints are properly guarded. _______ _______
- All pulleys, belts and gears are properly guarded. _______ _______
- All guards are in place (fans, centrifuges, drive belts etc.). _______ _______