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Date of Inspection:_______________  Location:____________________________________

Name of Inspector:___________________________________

Mark the appropriate letter in the Rating column next to the item inspected.  S = Satisfactory (needs no attention).   A = Acceptable (may need some attention).   U = Unsatisfactory (requires attention).

Rating Inspection Item Remarks
  Aisles, hallways and stairs clear of obstructions  
  Adequate lighting  
  Exposed or damaged wiring  
  Safety barriers and signs  
  Emergency equipment accessible (fire extinguishers, eye wash, first aid kit, etc.)  
  Compressed gas cylinders secured  
  Slip/trip/fall hazards  
  Wet floors/stairs  
  Storage 18" below plane of sprinkler heads or 24" below ceilings of unsprinklered areas  
  Chemicals properly stored and secured  
  Adequate containment and routine disposal of trash, debris, garbage, hazardous waste, etc.  
  Overall cleanliness  
  Other