Safety Inspection Checklist WORD Format

SAFETY INSPECTION COMPLIANCE CHECKLIST

I. GENERAL INFORMATION

Inspection Date: [___________]
Facility Name/Location: [___________]
Department/Area: [___________]
Inspector Name: [___________]
Job Title: [___________]
Supervisor in Charge: [___________]

II. INSPECTION SCOPE & CRITERIA

This document serves as a formal record of safety compliance. All items must be evaluated for adherence to internal safety policies, OSHA standards, and applicable local/state regulations.

(P = Pass | F = Fail | NA = Not Applicable)

III. DEFICIENCIES & REMEDIATION PLAN

Identify all items marked "Fail" in the table above and provide a remediation plan.

1. Deficiency: [____________________________________________________________________]
   Required Action: [________________________________________________________________]
   Target Completion Date: [___________]

2. Deficiency: [____________________________________________________________________]
   Required Action: [________________________________________________________________]
   Target Completion Date: [___________]

IV. INSPECTOR’S SUMMARY

General observations, notable hazards, or commended safety practices:
[____________________________________________________________________________________]
[____________________________________________________________________________________]

V. AUTHORIZATION & SIGNATURES

By signing below, the Inspector confirms that the inspection was conducted in accordance with established safety protocols. The Supervisor acknowledges receipt of this report and accepts responsibility for ensuring that all identified deficiencies are addressed within the designated timeframe.

Inspector Signature: ___________________________ Date: [___________]

Supervisor Signature: __________________________ Date: [___________]

Safety Officer/Manager Signature: ___________________________ Date: [___________]

The Checklist: Safety Inspection Checklist WORD Format

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

• Fire extinguishers are accessible, charged, and inspected.

• Emergency exits are clearly marked and unobstructed.

• All wiring, cords, and outlets are free of visible damage.

• Breaker panels are labeled and have 36" clearance.

• Aisles and walkways are free of slip/trip hazards.

• Proper lighting is maintained throughout the workspace.

• Employees are utilizing required Personal Protective Equipment.

• Materials are stacked securely to prevent falling.

• SDS sheets are current and readily accessible.

• Machinery guards and safety interlocks are functional.

• Completed by: [Full name]

• Signature: ______________________

• Date: [Date]