Instructions: This checklist addresses responsibilities and possible safety hazards which may be present in our work locations. Upon completion, the form is provided to the office manager and HR. For any items checked “Unsatisfactory” an explanation must be provided on an attached sheet.

Inspection Location


Housekeeping

Floor and aisles are free of litter and spilled liquids (water, pens, paper, etc.)

A Selection is Required.

Floors are free of cords, boxes, chairs and other tripping hazards

A Selection is Required.

Desks or file drawers are closed when not in use and only one drawer is used at a time

A Selection is Required.

Ergonomics

All office equipment is being used correctly

A Selection is Required.

Employees are properly positioned at their desk and maintain good neutral posture

A Selection is Required.

Employees are using their workstation efficiently and avoiding stretching or reaching for objects placed far away

A Selection is Required.

Electrical

All extension cords are in good condition and are not frayed

A Selection is Required.

Extension cords are not being used as permanent wiring

A Selection is Required.

Evacuation/Fire

Doors are labeled as exits

A Selection is Required.

Exit signs are installed and lit from an internal or external source

A Selection is Required.

Doors are not locked to prevent exit from building

A Selection is Required.

Fire doors are not propped open

A Selection is Required.

An evacuation plan is posted

A Selection is Required.

Fire extinguishers and pull stations are in the locations noted on the evacuation plan

A Selection is Required.

Fire extinguishers are identified with signs and not blocked

A Selection is Required.

Fire extinguishers appear to be in good condition and have been inspected

A Selection is Required.

Other Inspection Items

All areas are well lit and lights are functioning properly

A Selection is Required.

There are no observable drips or water damage

A Selection is Required.

Flooring is in good condition and the carpets are not ripped and tiles/flooring are not broken or uneven

A Selection is Required.

Employees are refraining from unsafe behaviors (i.e., standing on chairs, etc.)

A Selection is Required.

Warning signs are posted near hazards (wet floors, repair work, etc.)

A Selection is Required.

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