EmailMeForm
Monthly Station Safety Inspection Report
Key-
Enter "Y" if item meets criteria described and does not need attention.
Enter "N/C" if item needed attention but correction was made. Please State the correction.
Enter "N/M" if item needs attention and Maintenance Request is filled out and sent. Also, please describe the problem in the comments box if "N/M" has been entered.
Enter "N/A" if not applicable.
Date Time
MM
/
DD
/
YYYY
Name
First
Last
SCFD4 ID #
Email
Battalion:
Please select
1
2
4
6
9
Station Number
Please select
40
41
42
43
44
45
46
47
48
49
Verify EXIT signs are lit and in good shape; Sprinkler heads unobstructed; Fire Alarm pull-station unobstructed. Hold CTRL to select more than one.
*
Y
N/C
N/M
N/A
Please explain why maintenance is needed on the EXIT signs, sprinkler heads or Fire Alarm. And/or explain what correction was made. (You must still submit a maintenance request)
*
Stairways clean. sidewalks clear and free of tripping hazards, carpets have no fraying Hold CTRL to select more than one.
*
Y
N/C
N/M
N/A
Please explain why maintenance is needed on the Stairways, sidewalks or carpets. And/or explain what correction was made. (You must still submit a maintenance request)
*
36" clearance in front of electrical panels Hold CTRL to select more than one.
*
Y
N/C
N/M
N/A
Please explain why maintenance is needed on the clearance in front of the electrical panels. And/or explain what correction was made. (You must still submit a maintenance request)
*
Electrical cords in good condition and not overloaded (damaged wire, taped, or daisy-chained cords) Use surge protection strips in lieu of extension cords. Hold CTRL to select more than one.
*
Y
N/C
N/M
N/A
Please explain why maintenance is needed on the electrical cords. And/or explain what correction was made. (You must still submit a maintenance request)
*
Electrical switches, outlets and appliances in good repair. Hold CTRL to select more than one.
*
Y
N/C
N/M
N/A
Please explain why maintenance is needed on the electrical switches, outlets or appliances. And/or explain what correction was made. (You must still submit a maintenance request)
*
Fire extinguishers are charged, pins secure, mounted and tags current. Hold CTRL to select more than one.
*
Y
N/C
N/M
N/A
Please explain why maintenance is needed on the fire extinguisers, pins or mounted tags. And/or explain what correction was made. (You must still submit a maintenance request)
*
Floors have no oils or other slip/trip hazards. Floor drains are clean and work properly. Hold CTRL to select more than one.
*
Y
N/C
N/M
N/A
Please explain why maintenance is needed on the floors or floor drains. And/or explain what correction was made. (You must still submit a maintenance request)
*
All storage areas and closets clean and organized (all containers including non-hazard chemicals are labeled and closed). No chemicals stored in food cabinets. Hold CTRL to select more than one.
*
Y
N/C
N/M
N/A
Please explain why maintenance is needed on the closets or storage areas. And/or explain what correction was made. (You must still submit a maintenance request)
*
Weight room equipment inspected (check cables for fraying, damaged bars or bent items) Hold CTRL to select more than one.
*
Y
N/C
N/M
N/A
Please explain why maintenance is needed on the weight room equipment. And/or explain what correction was made. (You must still submit a maintenance request)
*
All doors (including overhead doors) open and close properly, including locks. (No obstructions)Hold CTRL to select more than one.
*
Y
N/C
N/M
N/A
Please explain why maintenance is needed on the doors. And/or explain what correction was made. (You must still submit a maintenance request)
*
Emergency gas shutoff works. No smell of gas around any appliances or BBQ. Hold CTRL to select more than one.
*
Y
N/C
N/M
N/A
Please explain why maintenance is needed on the emergency gas shutoff. And/or explain what correction was made. (You must still submit a maintenance request)
*
Chairs and tables in good repair. Hold CTRL to select more than one.
*
Y
N/C
N/M
N/A
Please explain why maintenance is needed on the chairs or tables. And/or explain what correction was made. (You must still submit a maintenance request)
*
All interior and exterior lights working; parking lot, flagpole, exterior building lights, (emergency lights when no automatic generator is present) **Night crew to check exterior lights** (Hold CTRL to select more than one.
*
Y
N/C
N/M
N/A
Please explain why maintenance is needed on the lights. And/or explain what correction was made. (You must still submit a maintenance request)
*
Other noted safety issues