OCCUPATIONAL HEALTH & SAFETY WORKPLACE INSPECTION REPORT
Inspector: ______________________ Workplace: ____________________ Date: _________________
Item HAZARD OBSERVED ACTION RECOMMENDED
URGENCY CORRECTIVE ACTION
1
Action Urgency: A = Immediate (Major) (Contact Supervisor) B = Short Term (Serious) (2 weeks) C = Intermediate Term (Minor)(1 month)
Additional Comments/Concerns from Staff:
Supplies/Equipment:
First Aid Kit: ____________________________________________________________
Supplies __________________________________________________
Respiratory Illness Kit:
required: __________________________________________________
Smoke Alarm/CO
__________________________________________________
Fire Extinguisher Checked:
Inspector Signature: ______________________________________
WORKPLACE INSPECTION FOLLOW UP REPORT:
Item CORRECTIVE ACTION TAKEN RESPONSIBILITY of DATE COMPLETED
1
If corrective action cannot be completed, state reason why and projected completion date:
Management Co-Chair Signature: ______________________________________ Date: _____________________________
Copy to: Chief Executive Officer Employee Co-Chair Supervisor Inspector JHS Committee
INSPECTION CHECKLIST
Inspector (s)
Location: Date:
Satisfactory X Unsatisfactory, requires attention
WORKSTATIONS/OFFICE AREAS
□ Temperature is kept at a minimum of 18°C
□ Liquid/tablet detergents are used over powdered detergent
□ All cords are secure/area is free of trip hazards
□ Spill procedures and mop stations are in place
□ All electrical cords in good repair/not frayed PERSONAL PROTECTIVE EQUIPMENT
□ File cabinets are secure/no top heavy drawers □ Training is provided to ensure the correct use and proper
maintenance of PPE
□ Carpeted areas are in good repair
□ Appropriate PPE is available
□ Air exchange sufficient/no complaints about air quality
□ PPE is worn in designated areas/tasks
□ Workstation meets sound ergonomic practices
□ Eye wash station is in working order and accessible
□ Consistently used items are within easy reach
□ Respiratory illness kit is available on site and stocked
□ Workstations are free of clutter
□ Chair provides proper posture/support to the individual
FIRST AID
□ Chair is adjustable
□ A First Aid kits are readily available
□ Work area is clear of trip hazards
□ Employee Injury packages are in stock
□ Fire extinguishers are readily available
□ Certified employees are identified and posted
□ First Aid kits are stocked as per Reg 1011
FIRE SAFETY
□ An effective fire alarm system is in place
ADMINISTRATION
□ The fire alarm system is tested on a regular basis
□ The Health and Safety policy is reviewed annually and posted
□ The fire alarm is functioning correctly
□ A Health and Safety Committee is established within the agency
□ Fire exits are clearly marked and easily accessible
□ Health and Safety Committee Members/Representatives are posted
□ All exits are free from obstruction
□ A Health and Safety bulletin board is in place/appropriate location
□ Emergency procedures are posted
□ Employees are consulted regarding Health and Safety issues
□ Emergency telephone numbers are posted
□ All accident/incident/hazards are reported, recorded and investigated
□ Regularly scheduled fire drills are in place
□ An Early and Safe Return to Work Program is in place
□ Fire extinguishers are suitable for the type of hazard
□ Health and Safety is a standing agenda item at General Team
Meetings/Committee Meetings
□ Fire extinguishers are checked/tag initialled
MANUAL MATERIALS HANDLING
□ Fire sprinkler system is installed/unobstructed
□ The need to lift,/carry/push is eliminated as much as possible
□ Carbon dioxide detectors are in place where needed
□ The need for prolonged bending is eliminated as much as possible
□ Smoke alarms/heat sensors are in place where sprinklers
aren’t present □ Workers are trained in proper manual lifting techniques/back care
□ There is less than 20% artwork on walls □ Material/equipment is stored at an appropriate height
□ Flammable materials are properly stored INFECTION CONTROL
LIGHTING □ There are procedures in place to monitor attendance record to
identify cluster of illness
□ All areas are adequately lit
□ The Infection Control Policy is reviewed annually
□ The emergency lighting system is adequately
maintained/battery charged □ Standard/Universal precautions are practiced
□ All light fixtures are clean and in good repair □ A hand sink is available and equipped
□ All fire exit signs are in proper working order □ Hand washing signs are posted
HAZARDOUS SUBSTANCES
□ Non-latex/powder-free latex gloves are available
□ All employees are trained in WHMIS/consumer products
□ Appropriate waste disposal procedures are in place
□ There is a current inventory list of all hazardous substances SLIPS, TRIPS, FALLS
□ MSDS (Material Safety Data Sheets) are current and readily □ Floor is free of tripping hazards
available □ Furniture is arranged to prevent obstacles
□ All containers are adequately labelled □ Doors are not obstructed by mats
□ All chemicals are safety stored □ Walkways are not a source of trip/slip hazards
