Facility Inspection Checklist
Facility/Site Inspected: Date Completed: _
GENERAL SAFETY Inspection Completed by:
Explain all negative responses. Include locations in your explanations of specific concerns. Use N/A when appropriate.
Page 1 of
Facility Inspection Checklist
Facility/Site Inspected: Date Completed:
FIRE & ELECTRICAL HAZARDS Inspection Completed by:
Explain all negative responses. Include locations in your explanations of specific concerns. Use N/A when appropriate.
Unable to
FIRE & ELECTRICAL HAZARDS PREVENTION AND SAFETY YES NO N/A
B. Determine
10. Is an adequate number of portable fire extinguishers provided so that they are readily accessible in the case of an emergency?
11. Are portable fire extinguishers mounted, located and easily identifible?
Are portable fire extinguishers visually inspected each month?
12.
(There is an inspection card on all fire extinguishers that needs to be dated and signed monthly.)
Are annual maintenance checks of portable fire extinguishers completed and do inspection tags on each extinguisher reflect
13.
the date completed?
14. Are all fire alarms functioning properly and tested annually? Date of most recent test:
15. Are planned and unplanned fire drills conducted at regular intervals? Date of most recent drill:
16. Are electrical outlets adequate (no overloads or unapproved extension cords in use)?
17. Are electrical and extension cords used to connect equipment undamaged?
Are all employee lounge areas free of any visual evidence of a fire hazard or violation?
18.
(Please document any specific concerns in the "Comment" section below)
19. Are electrical panels labelled properly and free of defects?
20. Are areas surrounding the electrical panel(s) free of flammable, hazardous, combustible material?
20. (a) If no, is there a miniumum clearance of 36" surrounding the electrical panel(s), as required by the State Fire Code?
21. Are electrical closets free of storage?
Fire & Electrical Hazard Prevention and Safety Concerns And Other Related Comments :
Page 2 of
Facility Inspection Checklist
Facility/Site Inspected: Date Completed:
GENERAL ENVIRONMENTAL CONTROL Inspection Completed by:
Explain all negative responses. Include locations in your explanations of specific concerns. Use N/A when appropriate.
Unable to
GENERAL ENVIRONMENTAL CONTROL - HOUSEKEEPING YES NO N/A
C. Determine
Are carpeted floors clean and are there no areas where there are loose carpet, rips or bumps?
22.
(Indicate specific carpeting concerns and their locations in the "Comments" section below)
23. Are all carpeted areas free of safety concerns, such as tripping hazards?
Are uncarpeted floors clean, slip-resistant, in good repair with treads in place? (Indicate
24.
specific flooring concerns and their locations in the "Comments" section below)
25. Are warning signs and/or mats provided when floors are wet?
26. Are restroom facilities clean and sanitary?
27. Are restroom facilities adequately stocked with the necessary supplies?
28. Are staff lounge and eating areas clean and sanitary?
29. Are drinking fountains clean and in good working order?
30. Are work areas free of rodents, insects and vermin?
30.(a) Any potential for rodent, mosquito, fly or roach breeding/infestation should be documented in the "Comments" section below.
31. Are ceiling fan blades safe and clean?
32. Are the waste receptacles emptied regularly?
33. Are the adequate type (tight-fitting covers where needed) and number of waste receptables provided?
34. Are storage areas clean and clear of debris or clutter?
35. Are walls and woodwork clean?
Are there cleaing schedules for issues employees are responsible for, such as cleaning refrigerators, microwaves, stoves,
36. toasters, dishes, etc.?
36.(a) Fogging of the surrounding areas are performed at regular intervals?
General Environmental Control - Housekeeping Concerns And Other Comments:
Page 3 of
Facility Inspection Checklist
Facility/Site Inspected: Date Completed:
EGRESS Inspection Completed by:
Explain all negative responses. Include locations in your explanations of specific concerns. Use N/A when appropriate.
Unable to
EGRESS YES NO N/A
D. Determine
Are devices or alarms, which were installed to restrict the improper use of an exit, installed and functioning so that they cannot
37.
impede emergency use of such exit?
38. Are all emergency exit doors clearly marked and functioning properly?
39. Are emergency and exit lights in working order?
40. Are doors arranged to be readily opened from the egress side whenever the building is occupied?
41. Are all exits marked by a readily visible sign with letters at least six inches high and three-fourth inches wide?
42. Where exits are not readily visible, are the accesses to the exits marked by readily visible signs?
43. Are means of egress (i.e. hallways and stairways) continually maintained free of all obstructions or impediments?
44. Are halls, stairwells, and exits clear of boxes, furnishings, clutter, etc?
45. Are stairways well lighted, handrails in good condition and stair treads in place?
46. Are closed stairways provided with a railing on at least one side?
Egress Concerns And Other Comments:
Page 4 of
Facility Inspection Checklist
Facility/Site Inspected: Date Completed:
MAINTENANCE Inspection Completed by:
Explain all negative responses. Include locations in your explanations of specific concerns. Use N/A when appropriate.
Unable to
MAINTENANCE (Exterior and Interior) YES NO N/A
E. Determine
47. Are doors and locks in good working order?
48. Are ceiling tiles intact, undamaged and in place?
49. Are there no signs of weather damage or mold growth in the facility?
50. Are all windows unbroken and free from any type damage?
51. Do air conditioning vents and ducts appear to be clean upon visual inspection?
52. Are outside lights in good working order?
53. Does the exterior of the building present no safety concern?
54. Is the parking lot area free of any safety concern (i.e. overgrown landscaping, uneven pavement, traffic hazards)?
Maintenance (Exterior and Interior) Concerns And Other Comments:
Page 5 of
Facility Safety Inspection Checklist
Facility/Site Inspected: Date Completed:
SITE-SPECIFIC Inspection Completed by:
Explain all negative responses. Include locations in your explanations of specific concerns. Use N/A when appropriate.
Unable to
SITE-SPECIFIC STANDARDS YES NO N/A
F. Determine
1. Standard fire orders sign clearly visible
2. First aid clearly visible
3. Lighting adequate and operational
4. Temperature is comfortable
5. Area is free from odours
6. Noise level is acceptable/adequate controlled
4. Ventilation is adequate
5. Stair treads in good condition
6. Handrails present, safe and secure
7. Electrical equipment tested, tagged, and in date
8. Electrical switches/sockets in good condition
9. Furniture safe and undamaged
10. Access and egress paths clear
11. First aid kit accessible
12. Fire fighting equipment easily accessible
Page 6 of
HFacility Safety Inspection Checklist
Facility/Site Inspected: Date Completed:
SITE-SPECIFIC Inspection Completed by: __________________________________________________________________________________________________
Explain all negative responses. Include locations in your explanations of specific concerns. Use N/A when appropriate.
Unable to
SITE-SPECIFIC STANDARDS YES NO N/A
F. Determine
13. Fire fighting equipment checked in last 6 months
14. Kitchen drains (floor and sink) clear and free flowing
15. Kitchen taps free from drips
16. Kitchen fridge clean, good condition
16. Kitchen microwave clean and maintained
17. Kitchen oven/stove safe and clean
18. Gas supply secured to gas cooker/heater
19. Kitchen area free from pests or evidence thereof
20. Seating available and safe
21. Tables safe and clean
22. Waste and cigarette butt bins available
23. Washing line safe and in good condition
24. Boundary fences safe and secure
25. Overhead structures safe and secure
26. Fogging of the surrounding area is performed once a week
Facility Safety Inspection Checklist
Facility/Site Inspected: Date Completed:
SITE-SPECIFIC Inspection Completed by: __________________________________________________________________________________________________
Explain all negative responses. Include locations in your explanations of specific concerns. Use N/A when appropriate.
Unable to
SITE-SPECIFIC STANDARDS YES NO N/A
F. Determine
27. Malaria test is provided to occupants every month
28. Occupants are provided with malaria drugs on a needed basis
Site-Specific Concerns And Other Comments:
1/1
