Corridor Safety Assessment Form
Please complete this form to assess and report safety conditions in the corridor.
Corridor Location
*
Date and Time of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Observed Hazards (select all that apply)
*
Obstructed Pathways
Wet or Slippery Floors
Poor Lighting
Damaged Flooring or Carpets
Exposed Cables or Wires
Other
Risk Severity
*
Low
Medium
High
Description of Issues or Observations
*
Upload Photos (optional)
Upload a File
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of
Recommended Corrective Actions
Inspector Name and Contact Information
*
Submit Assessment
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