/safety Inspection Checklist Form

SAFETY INSPECTION CHECKLIST AND COMPLIANCE REPORT

Document ID: [____________________]
Date of Inspection: [____________________]
Facility/Site Name: [__________________________________________________]
Site Location/Address: [__________________________________________________]
Inspector Name: [__________________________________________________]
Inspector Title/Role: [__________________________________________________]

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I. GENERAL FACILITY INFORMATION

• Department/Area Inspected: [__________________________________________________]
• Time of Inspection: [____________________]
• Last Inspection Date: [____________________]
• Current Occupancy/Staff Count: [____________________]

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II. SAFETY COMPLIANCE CHECKLIST

Please mark each item as: (C) Compliant, (NC) Non-Compliant, or (N/A) Not Applicable.

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III. INCIDENT REPORTING & CORRECTIVE ACTION PLAN

Provide details for any items marked "Non-Compliant" (NC) and define the timeline for remediation.

1. Non-Compliance Item: [__________________________________________________]

   • Required Action: [__________________________________________________]
   • Responsible Party: [__________________________________________________]
   • Expected Date of Completion: [____________________]

2. Non-Compliance Item: [__________________________________________________]

   • Required Action: [__________________________________________________]
   • Responsible Party: [__________________________________________________]
   • Expected Date of Completion: [____________________]

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IV. INSPECTOR COMMENTS & CERTIFICATION

Additional Observations:
[____________________________________________________________________________________]
[____________________________________________________________________________________]

Certification:
I hereby certify that the information provided in this document is accurate to the best of my knowledge and reflects the safety status of the designated area at the time of inspection.

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V. SIGNATURE BLOCKS

Inspector Signature:

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Date: [____________________]

Site Manager/Supervisor Signature:

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Date: [____________________]

Safety Officer/Department Head Signature:

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Date: [____________________]

The Checklist: /safety Inspection Checklist Form

Work through the list and tick each item as it is completed.

• Fire extinguishers charged and accessible

• Emergency exits unobstructed

• Exit signs illuminated/visible

• Fire alarm system operational

• Chemicals stored and labeled properly

• SDS available for all hazardous materials

• Spill kits fully stocked

• Proper PPE available and in use

• Cords/cables in good repair

• Electrical panels accessible (36" clearance)

• Machinery guards in place

• Walkways clear of debris/trip hazards

• Lighting levels adequate for tasks

• Waste disposal and recycling bins labeled

• Completed by: [Full name]

• Signature: ______________________

• Date: [Date]