Workplace Safety And Health Inspection Form


Safety Inspection Form
The primary consideration in conducting inspections is to enhance workplace safety and health and to decrease
the frequency or severity of work-related injuries and illnesses. Inspections contribute to safe working conditions
and practices for all employees through the implementation and maintenance of occupational safety and health
programs. The effect by these regulations helps reduce workers' compensation costs. The goal is a safe and
healthy work place.
The method for identifying, evaluating, and documenting safety and health hazards are done through site
inspections. An example of the inspection form being used is on the following page. The next page illustrates how
the form is filled out during an actual inspection. The third following page is a Safety Inspection Response Form
which is given to the department supervisor(s) following a safety inspection. This form is to be used by the
supervisor(s) to indicate the actions taken to remedy the safety concerns found in their area(s) during the
Safety Inspection Guidelines
The following steps are guidelines that help safety committee chairperson(s) to conduct inspections:
Assign safety committee members to specific areas/buildings to conduct inspections.
Meet with committee members to explain the inspection process and how to complete the form.
Go through assigned area(s) and look for obstructed doorways/exits, overloaded outlets,
exposed electrical wires, cords that could cause one to trip, burned out EXIT lights, etc.
Indicate on the Inspection Form if the potential hazard is an immediate/life threatening danger
or a safety concern. (Example: exposed electrical wires would be an immediate danger and a
burned out light bulb would be a safety concern.)
Number each safety concern under the Item # column, so it can easily be identified on the Response Form.
Set deadline to complete inspections.
Collect completed inspection form(s) from committee members.
Give completed Inspection Form(s), along with blank Response Form(s), to appropriate department
supervisors. If there is more than one supervisor per building, make the necessary number of copies of
the completed Inspection Form(s) for each supervisor affected.
On the Safety Inspection Form, mark which item numbers (Item #) affect
each particular supervisor.
Then write those same item numbers (Item #) on the Response Form. Make sure the supervisor(s)
understands that the item numbers (Item #) on the Inspection Form correspond with the same item
numbers (Item #) on the Response Form.
Have the department supervisor complete the Inspection Response Form by indicating what actions were
taken to remedy the concerns found during the inspection.
Request that the supervisor(s) complete a work order on any item(s) needing repair or other attention
and then submit it to the Maintenance Department.
Collect completed Response Forms within 5 working days.
File completed Inspection and Response Forms in Inspection Form Book. (Each campus should maintain
its own Inspection/Response Form Book.) Use these completed forms as a reference when doing next
inspection in same area to make sure concerns/hazards were addressed after last inspection.
Reminder: ALL college employees have the ability to report safety concerns.
Safety Inspection Form on Following Page


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