Date of Inspection:

[Month, Day, Year]

Time of Inspection:

Inspection Frequency:

Location/Department:

Inspector(s):

1. Fire Safety

[Month, Day, Year]

[00:00] AM/PM

2. Electrical Safety

3. Ergonomics

4. Chemical Handling

5. General Safety

1

• Replenish fire extinguishers that are low on extinguishing agents.

• Replace a malfunctioning fire alarm in the east wing.

• Relocate flammable materials to the designated storage area.

Pass

2

• Repair the damaged electrical outlet in the breakroom.

• Ensure all circuit breakers are clearly labeled for quick identification.

• Cover exposed wires near the main entrance.

• Provide additional grounding for the machinery in the workshop.

3

• Adjust workstation heights to match employee preferences.

• Replace non-adjustable chairs with ergonomic chairs.

• Reposition monitors to reduce glare.

• Install task lighting to improve visibility.

4

• Re-label chemical containers with proper hazard warnings.

• Ensure all MSDS are up-to-date and readily accessible.

• Distribute missing personal protective equipment (PPE) to employees.

• Improve ventilation in the chemical storage room by installing exhaust fans.

5

• Clear walkways and aisles of any obstructions.

• Place wet floor signs near spill-prone areas.

• Unblock emergency exits and establish clear pathways.

• Repair damaged safety railings and barriers along the loading dock.