Home Office Safety Checklist Form

Home Office Safety Checklist Form

Please fill out this form completely to ensure your home office is safe and compliant with health and safety guidelines.

Personal Information

Name

    Address

      Phone number

        Email

          Checklist

          #

          Safety Item

          Yes

          No

          1

          Are your work areas well-lit?

          2

          Is your workstation ergonomically designed (e.g., proper chair, desk height)?

          3

          Do you have adequate ventilation in your office space?

          4

          Are electrical cords safely secured to avoid tripping hazards?

          5

          Is there a smoke detector installed in your office space?

          6

          Do you have an accessible first aid kit nearby?

          7

          Are your office supplies and equipment in good working condition?

          8

          Is there a fire extinguisher in your home office?

          9

          Are any chemicals or hazardous materials properly stored and labeled?

          10

          Do you have an emergency evacuation plan in place?

          Signature

          By signing this form, I confirm that the information provided is accurate and that my home office meets the safety standards outlined above.

          Name:

          Date:

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