SAMPLE SAFETY INSPECTION CHECKLIST

NAME OF AGENCY/OFFICE: _____________________________________________________________

Area(s) Inspected: _____________________________Inspected by:

_______________________Date:____________

CORRECTIVE
ITEM YES NO
ACTION DATE
1. Is there litter or spilled liquid on the floor?
Are floor surfaces chipped: does carpeting
2.
show worn spots or holes?
Are warning signs posted near cleaning areas,
3.
repair work or redecorating efforts?
Are aisles free of boxes, wastebaskets, chairs,
4.
and other obstacles that impede traffic?
5. Are restrooms kept clean and floors dry?

6. Do cords present a tripping hazard?

7. Do cords look frayed?

Are cords draped over hot pipes and/or
8.
appliances?
9. Are flimsy extension cords in use?
Are all appliances connected with three-
10.
pronged plugs?
Are electrical outlet boxes or bonnets exposed
11.
so that they present a hazard?
Are cover plates for electrical switches or
12.
receptacles cracked or broken?
Do employees stand on chairs, desks, boxes,
13.
drawers, or other improvised ladders?
Do employees lean way back in chairs with
14.
their feet off the floor?
Do employees put tops on cups of coffee or
15. other liquids while carrying them through the
office?
16. Do employees run in the office?

17. Are stairwells well lit?

Are stairway handrails, treads and/or risers in
18.
good condition?
19. Are stairs free of litter, spills or clutter?

20. Are desk or file drawers left open?

Are files, lockers, cabinets, and bookcases
21.
bolted securely?
22. Is more than one file drawer open at once?
Are files top-heavy with empty drawers at the
23.
bottom and full drawers on top?
Are transparent glass doors marked so they
24.
can be seen?
Must employees step up or down to go through
25.
a doorway? If so, is a warning sign posted?
Do self-closing doors have too much spring
26.
tension?
27. Is machinery turned off when not in use?
Do employees wear dangling jewelry or
28. clothing, such as a mens necktie, around
machinery?
Are employees using spike files (a piece of
metal about four (4) to six (6) inches in length
29.
that is attached to a small board and is
designed to hold papers, especially receipts)?
Are pencils kept in pencil holders with the
30.
points down?
Are paper cutters kept in a safe location with
31. the blade secured in the down or closed
position?
 CORRECTIVE
ITEM YES NO
ACTION DATE
32. Are razor blades or pins kept with paper clips?

33. Are fire exits clearly marked?

Are fire extinguisher locations marked in such a
34.
way that they are visible from a distance?
35. Are fire extinguisher tags current?

36. Are fire extinguishers readily available?

Do all employees know the locations of the
37.
exits, alarms, and extinguishers?
Are nonflammable fluids used whenever
38.
possible?
Are flammable liquids/fluids stored in approved
39.
containers?
Are emergency numbers for medical, fire, law
40.
enforcement/security and ambulance posted?
41. Are fire drills conducted frequently?

42. Do designated smoking areas have ashtrays?

Are combustible materials stored near
43.
machinery or heat sources?
Are features of fire protection, such as
44. sprinklers, fire alarms and hoses, kept clean
and in good working order?
Are the tags on the features of fire protection
45.
current?
Are doors to enclosed stairwells kept closed at
46.
all times?
Are company parking lots well lit and clearly
47.
marked?
48. Is medical help readily available?

49. Are adequate first-aid supplies available?

Are all incidents/accidents properly reported,
50.
investigated and documented?
MISCELLANEOUS:
Are Safety Inspections conducted in
51. accordance with the time frame specified in the
agencys loss prevention manual?
Are Safety Meetings conducted in accordance
52. with the time frame specified in the agencys
loss prevention manual?
Are Hazard Control Logs posted throughout the
53.
workplace?
Is the Workers Compensation Notice of
54.
Compliance posted?
55. Is the safety bulletin board current?

56. Do agency drivers use safety belts?

Are there items carried over from previous
57.
reports?

OVERALL EVALUATION:

EXCELLENT

SATISFACTORY

UNSATISFACTORY