Energy Facility Safety Assessment Form
Use this form to assess safety conditions, identify hazards, and record follow-up actions for an energy facility.
Facility and Inspection Context
Facility Name
*
Facility Type
*
Power Generation
Substation
Battery Storage
Transmission/Distribution
Renewable Energy Site
Other
Site Location
*
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Safety Assessment Details
Overall Safety Condition
*
Poor
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Poor, 10 is Excellent
Key Safety Checkpoints
*
Rows
Compliant
Needs Attention
Not Applicable
Emergency Exits
1
2
3
Safety Signage
4
5
6
Fire Protection Equipment
7
8
9
Electrical Hazard Controls
10
11
12
Access Control
13
14
15
Housekeeping
16
17
18
Overall Risk Level
*
Low
Moderate
High
Critical
Other
Observed Issues / Hazards
Blocked emergency exit
Missing or damaged safety signage
Fire extinguishers inaccessible or overdue for inspection
Exposed electrical conductors or damaged cabling
Inadequate lockout/tagout controls
Unauthorized access points unsecured
Poor housekeeping or debris accumulation
Leak, spill, or contamination concern
Insufficient lighting in critical areas
Other
Inspector Notes and Follow-up
Corrective Actions Required
*
Inspector or Assessor Name
*
First Name
Middle Name
Last Name
Submit Assessment
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