Safety Inspection Task Checklist Form
Complete this form to document workplace safety inspections, checklist results, and any hazards or follow-up actions.
Inspector Name
*
First Name
Last Name
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Area/Location Inspected
*
Type of Inspection
*
Routine
Follow-up
Incident-related
Other
Safety Checklist
*
Emergency exits accessible
Fire extinguishers present & accessible
First aid supplies available
Walkways clear of obstructions
Electrical cords in good condition
Personal protective equipment used
Were any hazards or deficiencies identified?
*
No
Yes
If hazards/deficiencies were found, describe them
Immediate corrective actions taken
Overall safety rating for this area
*
1
2
3
4
5
Additional notes or follow-up actions required
Submit Inspection
Should be Empty: