OHS MOD GF 14

Office or Workplace HSE Inspection

Note: If part of the form is not applicable then the field must be crossed out or "N/A" must be noted.

Frequency: Monthly

Office/ Location Floor Room area

Yes/ Date closed

Deficiency noted Location/Area Action required
No out

Section I: Walking/Working Surfaces

Yes
a. Slippery or uneven surfaces
No
b. Torn or loose floor covering,
loose objects on walking Yes
surface, or protruding floor No
outlets.

c. Floor is rough, splintered or Yes

has protrusions. No

d. Spilled liquids, (water, Yes

coffee, oil, etc.) No

e. Illumination inadequate, Yes

glare, etc. No
f. Stairs tread defective or Yes
missing, stairs unequal in
height or width. No

g. Handrails missing or Yes

improperly positioned or in
disrepair. No

h. Throw rugs with non-slip Yes

rubber backing not used. No

Section II: Overhead Hazards

a. Unsecured, unstable file Yes

cabinets, bookcases,
shelves. No

b. Overhead building Yes

conditions, ceiling fixture
fans, etc. No

c. Floor loading appears to Yes

exceed capacity. No
d. Materials or objects on
cabinets or window sills Yes
present poor housekeeping No
and improper storage.

Document Reference Number: ORG1-06-002-MOD-TS0-0-PRM-TEM-3168-00

Revision Number: 00
Date: 05 January 2020

Page 1True5
 Yes/ Date closed
Deficiency noted Location/Area Action required
No out

Section III: Means of Egress

a. At least two means of Yes

egress from the building are
not available. No

b. Exits not clearly marked, or Yes

emergency lights defective. No
c. Access doors blocked, path Yes
of escape too narrow, aisles
<28”. No

d. No dead-end corridor >50’,

maximum travel distance or Yes
path to exit 200’ (without
sprinkler system) or 250’ No
(with sprinkler system).
e. Furniture or other objects Yes
placed or stored blocking
escape route. No

Section IV: Furniture and Equipment

a. Defective wiring, switches,

extension cords, etc., Yes
exposed energized No
electrical parts.
b. Furniture or equipment
unsafe or defective (sharp Yes
edges, burrs, etc.); chair No
needs adjustment.

c. Broken or chipped Yes

glass/plastic. No
d. Unauthorized electrical
equipment, hot plates, Yes
heaters, fans, extension No
cords, etc.

e. Ladders or step stools Yes

unsafe or unavailable. No

f. Liquids stored in or around Yes

electrical equipment. No

g. Electrical panel doors Yes

blocked. No

h. Electrical panels doors not Yes

properly closed or secured. No
i. Filing cabinet’s not properly
utilized (second drawer of Yes
four-drawer cabinets filled
first) and materials not No
evenly distributed.

Document Reference Number: ORG1-06-002-MOD-TS0-0-PRM-TEM-3168-00

Revision Number: 00
Date: 05 January 2020
Form Page 2True5
 Yes/ Date closed
Deficiency noted Location/Area Action required
No out
j. Bookcases taller than 64” Yes
not secured/anchored to the
wall. No

k. Paper cutters/guillotines
improperly guarded and/or Yes
not secured when not in No
use.

Section V: Fire Prevention

a. Fire alarm system not tested Yes

or annual fire drills not
completed. No

Yes
b. No Fire Wardens identified.
No
c. Inadequate storage of Yes
flammables, chemicals, and
waste. No

d. Smoke detectors not Yes

installed, operational, and/or
improperly tested. No

Yes
e. Poor housekeeping.
No
f. Fire extinguishers are not
the proper type, not
conspicuously located, not
readily accessible, Yes
improperly mounted, not No
visually inspected monthly,
or no maintenance check
performed annually.
g. Evidence of smoking in “NO
SMOKING” area or within Yes
50’ of common entrance/exit No
way.

Section VI: Industrial Hygiene

a. Sanitary facilities not Yes

maintained. No
b. Reports of hazardous Yes
fumes, vapours, asbestos,
or poor ventilation. No

c. Noise levels exceed TWA of Yes

85 dBA. No

Section VII: Hazardous Materials

a. No MSDS for hazardous Yes

chemicals stored or in use. No
b. Chemicals are not properly Yes
labelled. No
c. Incompatible storage.
Yes

Document Reference Number: ORG1-06-002-MOD-TS0-0-PRM-TEM-3168-00

Revision Number: 00
Date: 05 January 2020
Form Page 3True5
 Yes/ Date closed
Deficiency noted Location/Area Action required
No out
No
d. Hazard communication
Yes
training not conducted
No
and/or documented.
Section VIII: Other

a. Pre-accident and Yes

Emergency Response Plan
out of date. No

b. Evacuation plans posted in Yes

conspicuous location. No

c. First aid kit not available Yes

and/or accessible. No
Yes
d. No First Aiders identified.
No

e. Air vents unclean and/or Yes

obstructed. No

f. Thermostats unclean and/or Yes

obstructed. No
g. Radiators (steam heating Yes
systems) unclean and/or
improperly functioning. No

Yes
h. Evidence of pests observed.
No

i. Trash and/or recycle Yes

containers not emptied. No
j. Safety training not Yes
conducted and/or
documented. No

Remarks

Document Reference Number: ORG1-06-002-MOD-TS0-0-PRM-TEM-3168-00

Revision Number: 00
Date: 05 January 2020
Form Page 4True5
 Inspector’s Name Signature Date

Document Reference Number: ORG1-06-002-MOD-TS0-0-PRM-TEM-3168-00

Revision Number: 00
Date: 05 January 2020
Form Page 5True5