Space Heater Safety Checklist Form
Conduct a safety inspection to ensure the space heater is set up and operated in a safe environment. Complete all checklist items for a thorough assessment.
Location of Space Heater
*
Is the space heater in good working condition (no visible damage, clean, all parts intact)?
*
Yes
No
Needs Maintenance
Is there at least 3 feet (1 meter) of clearance around the heater (free from curtains, furniture, or other combustibles)?
*
Yes, clear on all sides
Partially clear
No, not clear
What type of electrical setup is used for the heater?
*
Directly plugged into wall outlet
Plugged into surge protector
Plugged into extension cord
Other
Is the power cord and plug in safe condition (no fraying, damage, or exposed wires)?
*
Yes
No
Needs Replacement
Is the heater placed on a stable, level surface and not at risk of tipping over?
*
Yes, stable and level
Somewhat unstable
At risk of tipping
Is the heater supervised while in use or equipped with a timer/automatic shutoff?
*
Supervised during operation
Equipped with timer or auto-shutoff
Neither
Are there any potential fire hazards nearby (e.g., papers, flammable liquids, overloaded outlets)?
*
No hazards detected
Papers or magazines
Flammable liquids/chemicals
Overloaded electrical outlets
Other hazard
Overall risk assessment for this space heater setup
*
1
2
3
4
5
Corrective actions taken or recommended
*
Inspector comments or additional notes
Submit Inspection
Should be Empty: