Pre-Operational Safety Clearance Inspection Form
Complete this form to document and certify safety clearance prior to operation.
Inspector Name
*
First Name
Last Name
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspection Time
*
Hour Minutes
AM
PM
AM/PM Option
Location of Inspection
*
Equipment or Area Inspected
*
Are all safety guards and controls in place and functioning?
*
Yes
No
Not Applicable
Are hazard warning signs clearly visible and undamaged?
*
Yes
No
Not Applicable
Are emergency stop mechanisms operational?
*
Yes
No
Not Applicable
Are walkways and work areas free of obstructions and hazards?
*
Yes
No
Not Applicable
Additional Comments or Observations
Inspector Signature
*
Submit Inspection
Submit Inspection
Should be Empty: