OSHA Safety Evaluation Checklist Form
Use this form to evaluate workplace safety conditions, record hazards, and note corrective actions during an OSHA safety inspection.
Workplace Inspection Details
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Facility/Site Name
*
Department or Area Inspected
*
Inspector Name or Role
*
Safety Evaluation Checklist
Safety conditions evaluated
*
Housekeeping
Signage
PPE availability
Machine guarding
Emergency exits
Fire extinguishers
Electrical safety
Aisle clearance
Hazard communication
Spill control
Other
Overall compliance level
*
Non-compliant
1
2
3
4
5
6
7
8
9
Fully compliant
10
1 is Non-compliant, 10 is Fully compliant
Number of hazards observed
*
Priority level of findings
*
Low
Medium
High
Critical
Comments and corrective actions
Reviewer Summary
Overall Evaluation Result
*
Pass
Needs Improvement
Fail
Follow-up Comments / Corrective Action Plan
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