Safety Footwear Inspection Checklist Form
Use this form to document the inspection of safety footwear in the workplace, ensuring compliance and safety standards.
Inspector Name
*
First Name
Last Name
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Department / Location
*
Worker or Item Identifier
*
Footwear Type
*
Please Select
Boots
Shoes
Clogs
Sandals
Other
Manufacturer / Brand
Size
Overall Condition Rating
*
1
2
3
4
5
Inspection Checklist – Mark each item as Pass or Fail
*
Rows
Pass
Fail
Toe Cap
1
2
Sole Tread
3
4
Upper Material
5
6
Stitching
7
8
Laces/Fasteners
9
10
Slip Resistance
11
12
Cleanliness/Damage
13
14
Final Disposition / Corrective Action Needed
*
Approved for Use
Repair Required
Replace Footwear
Other (specify)
Submit Inspection
Should be Empty: