OSHA Safety Evaluation Checklist Form

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
MonthDayYear
Date
Facility/Site Name
Department or Area Inspected
Inspector Name or Role
Safety Evaluation Checklist
Safety conditions evaluated
Other
Overall compliance level

1
2
3
4
5
6
7
8
9
10
1 is Non-compliant, 10 is Fully compliant
Number of hazards observed
Priority level of findings
Comments and corrective actions
Reviewer Summary
Overall Evaluation Result
Follow-up Comments / Corrective Action Plan
Should be Empty:

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