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1 WORKPLACE SAFETY INSPECTION CHECKLIST

1 Completed by: _____ Date: _____ Building: _____ Room: _____ Supervisor: _____ Phone: _____ Department: _____ Scheduled periodic inspections to identify unsafe conditions and work practices are supervisor requirements per Cal OSHA Title 8 CCR 3203(a)(4) and Stanford s Injury and illness prevention Program (IIPP). Stanford recommends completing the CHECKLIST on an annual basis. Completed copies shall be kept on file for at least one year by the supervisor or department SAFETY coordinator. Report any facility- related deficiencies below to the building manager. 1. GENERAL SAFETY YES NO N/A COMMENTS/DATE CORRECTED 1. WORKPLACE is clean and orderly. 2. Floors are clear and aisles, hallways, and exits are unobstructed.

CCR 3203(a)(4) and Stanford’s Injury and Illness Prevention Program (IIPP). Stanford recommends completing the checklist on an annual basis. Completed copies shall be kept on file for at least one year by the supervisor or department safety coordinator. Report any facility-related deficiencies below to the building manager. 1.

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