Inspector Name
Department
Date
Item | Status (Pass/Fail) | Issue / Location | Date Correction Requested | Date Completed | ||
|---|---|---|---|---|---|---|
A | B | C | D | E | ||
1 | Aisles and exits are free of obstructions. | Β | Β | Β | Β | |
2 | Carpets/mats are flat and free of trip hazards. | Β | Β | Β | Β | |
3 | No heavy items are stored on top of tall cabinets. | Β | Β | Β | Β | |
4 | Floors are dry and free of spills or debris. | Β | Β | Β | Β | |
5 | High-traffic areas are well-lit. | Β | Β | Β | Β |
Item | Status (Pass/Fail) | Issue / Location | Date Correction Requested | Date Completed | ||
|---|---|---|---|---|---|---|
A | B | C | D | E | ||
1 | Power strips are NOT "daisy-chained." | Β | Β | Β | Β | |
2 | Cords are not running across walkways. | Β | Β | Β | Β | |
3 | Electrical panels have 3ft (1m) clearance. | Β | Β | Β | Β | |
4 | Plugs/sockets show no signs of burning or fraying. | Β | Β | Β | Β | |
5 | Space heaters (if used) are plugged into wall. | Β | Β | Β | Β |
Item | Status (Pass/Fail) | Issue / Location | Date Correction Requested | Date Completed | ||
|---|---|---|---|---|---|---|
A | B | C | D | E | ||
1 | Fire extinguishers are charged and accessible. | Β | Β | Β | Β | |
2 | Exit signs are illuminated and functional. | Β | Β | Β | Β | |
3 | Emergency evacuation maps are clearly posted. | Β | Β | Β | Β | |
4 | Sprinkler heads have 18in (45cm) clearance. | Β | Β | Β | Β | |
5 | Fire doors are kept closed and unobstructed. | Β | Β | Β | Β |
Item | Status (Pass/Fail) | Issue / Location | Date Correction Requested | Date Completed | ||
|---|---|---|---|---|---|---|
A | B | C | D | E | ||
1 | Chairs provide lumbar support/adjustable height. | Β | Β | Β | Β | |
2 | Monitors are at the correct eye-level height. | Β | Β | Β | Β | |
3 | Under-desk space is clear for leg movement. | Β | Β | Β | Β | |
4 | Keyboards allow for neutral wrist positions. | Β | Β | Β | Β | |
5 | Lighting levels are adequate to prevent eye strain. | Β | Β | Β | Β |
Item | Status (Pass/Fail) | Issue / Location | Date Correction Requested | Date Completed | ||
|---|---|---|---|---|---|---|
A | B | C | D | E | ||
1 | First Aid kit is fully stocked and accessible. | Β | Β | Β | Β | |
2 | Cleaning chemicals are labeled and stored safely. | Β | Β | Β | Β | |
3 | Safety Data Sheets (SDS) are available. | Β | Β | Β | Β | |
4 | Air vents/diffusers are clean and unobstructed. | Β | Β | Β | Β | |
5 | Breakroom is clean and food stored properly. | Β | Β | Β | Β |
Manager/Supervisor Signature
Date of Final Review
Note on Compliance: Use the "Date Correction Requested" column the moment a hazard is identified during the walk-through. The "Date Completed" column should only be signed off once the inspector or safety officer has physically verified the fix.
Form Template Insights
Please remove this form template insights section before publishing.
When building a safety template, the goal is to create a functional bridge between observation and action. A checklist is not just a list of rules; it is a live document that records the physical state of a workplace at a specific moment in time.
Here are the detailed structural and operational insights into why this checklist is designed the way it is:
The "Status" column is the engine of the form. Using a simple Pass/Fail system serves three main purposes:
Including two separate date columns is the most critical part of an effective template.
The checklist is broken into "Sections" (Electrical, Fire, Ergonomics) rather than one long list for two reasons:
Without a specific location, a "Fail" status is useless. A detailed template must have a wide margin for notes.
The final signature block transforms the document from a "to-do list" into an Official Record.
Mandatory Questions Recommendation
Please remove this mandatory questions recommendation section before publishing.
While every item on a safety checklist contributes to a healthy environment, certain "mandatory" questions act as the foundation for office safety. These are non-negotiable because they address hazards that could lead to immediate physical harm or systemic failure during an emergency.
Here are the critical questions and the reasoning behind their inclusion:
To configure an element, select it on the form.