Date:
Building:
Inspector's Name:
Page 1
This document contains both information and form fields. To read information, use the Down Arrow from a form field.
Quarterly/Monthly Building Inspection Form
FIRE SAFETY AND EMERGENCY EQUIPMENT
Item
Yes No N/A Comments
1
Are all fire extinguishers visible & accessible? Are they
fully charged? (check for needle in the green) Is the pin in
place & secure?
2
Are fire extinguisher tags in place and less than one year
old? (check punched date for year & month)
3
Is the fire alarm system functioning properly and has it
been tested within the past year? (look for green
inspection tag by alarm control panel)
4
Are smoke alarms functioning correctly? (test each alarm,
push test button)
5
Are all exits marked with exit signs and illuminated? (if
battery operated, push test button)
6 Are evacuation plans posted near doors?
7
Are all doors and hallways leading to an exit, free to
access with no possibility of being locked in?
8 Are exit routes kept free of obstructions?
9
Do exit doors open outwards? Will fire & exit doors close
and latch properly?
10
Has a fire / evacuation drill been conducted within the past
year?
11
Do portable heaters have automatic shut off if tipped over?
Are portable heaters operated away from flammable
materials?
12
Are emergency phone numbers posted? (ex: security, fire,
ambulance)
13 Are emergency lights functioning correctly?
14
Are 1st aid kits visible & accessible? Are they stocked?
Are expiration dates current?
15 Are BBP spill kits stocked and accessible?
16 Is there at least 18" clearance for all sprinkler heads?
17
Are boxes, paper or other combustible items allowed to
accumulate that would present a fire hazard?
Quarterly/Monthly Building Inspection Form
Page 2
BUILDING AND OFFICE SAFETY
Item
Yes No N/A Comments
1
Are there any slip / trip / fall hazards located inside or
outside of the building?
2
In areas that may be wet, greasy or slippery are floor mats
or other anti-slip material used and in good condition?
3
Are service holes, man holes, drains, etc. properly
covered?
4 Is the building well lit, inside & outside?
5
Are floors in good condition with no loose or broken
flooring?
6
Are stairways in good condition with handrails in place?
Are stair treads in good condition?
7 Does the building have any pest problems?
8
Are all ceiling tiles in place and in good condition
throughout the building?
9
Is the building secure? Are all outside doors locked at the
end of each day? Are all locks and other security devices
functioning properly?
10
If equipped, is the security system for the building working
properly?
11
Are all maintenance and mechanical areas secure? (i.e.
boiler rooms, air handlers)
12 Do any windows have broken panes?
13
Are all elevators working correctly? Are elevators
equipped with an emergency phone?
14
Is the parking lot in good condition? (i.e. no potholes,
parking lines visible, etc.)
15
Are there any water leaks in the building? Note exact
location of leaks if it can be determined.
16
Are all plumbing systems working properly? (toilet flushing
problems, drainage problems, leaks from faucets, pipes,
etc.)
17 Are safety rules posted?
18
Do employees stand on chairs/desks instead of approved
ladders/stepstools?
19
Are hazardous materials stored properly if authorized in
area?
20 Are there any unauthorized hazardous materials in area?
21
Conduct and document regular testing of the eyewash
stations.
22 Implement air flow testing of its fume hoods in classrooms.
Quarterly/Monthly Building Inspection Form
Inspector's Signature Date
Page 3
ELECTRICAL SAFETY AND STORAGE METHODS
Item
Yes No N/A Comments
1
Are all breaker boxes labeled correctly? Are empty breaker
slots covered? Are the doors closed?
2
Do panel boxes have any hot spots? If so, note location of
hot spot & which panel box.
3
Check extension cords: are they properly grounded and
adequately sized for the current being drawn? Are they
placed in a manner to prevent tripping?
4 Check extension cords: are they damaged in any way?
5 Are outlets & switches covered properly?
6
Are storage areas neat? Are items stacked properly?
Are heavier items stored below shoulder height?
7 Do top shelves have overhang?
8
Are all custodial areas in good condition? Are chemicals
stored in appropriate container? Is this area secure?
9
Are flammable items stored in proper cabinets and/or
containers?
10 Are oxygen and/or acetylene tanks secured properly?
Other Building Safety Issues & Concerns Noted by the Inspector
Item Comments
Upon completion send a copy to the Safety Representative and keep a copy for your file. Any hazards found shall be
reported to the Safety Representative for corrections and/or follow-up.
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome