Facility Risk Assessment Questionnaire

Facility Risk Assessment Questionnaire
ServiceMaster anytime provides this safety information free of charge. These materials are provided as a service to our
clients and 866 Recover enrollees and is for information purposes only. This information is not a substitute for a thorough
analysis by one of your safety management specialists.
Business Name: _____________________________ Address:______________________________
City: ______________________ State: __________ Zip: __________________________________
Phone #1:____________ Back Up Phone #:______________ Key Contact: ___________________
Janitorial Service Provider: _____________________ Janitorial Contact Phone______________
Administrative Corrective Team Member

YES NO Action/Date Assigned
Written safety rules/safe job procedures in place
OSHA log updated/safety posters displayed
Management Safety Policy in place
All planned safety activities preformed (meetings,
inspections, training)
Effective new employee safety orientation
Exits, Walkways and Stairwells Corrective Team Member

All fire exits clearly marked
Walkways maintained, aisles defined, uncluttered
All exit doors in working order, free of any
hindrance, debris or obstructions
All fire doors open outward?
The stairwell side of the exit door marked with
LARGE bright floor numbers
All fire escapes inspected and serviced at least
quarterly
Fire doors have panic hardware
Unapproved doors clearly marked “NOT AN EXIT”
Sufficient emergency lighting heads
The emergency lighting system checked often
Emergency Medical Corrective Team Member
Emergency contact information posted
First aid responders available for each shift
Blood borne pathogens exposure potential
adequately addressed
First aid supplies adequate and available
Transportation available for injured workers/plan
in place
Trip/Slip and Fall Hazards Corrective Team Member

Portable ladders equipped with non‐slip feet.
Metal ladders marked ‐
“Do Not Use Around Electrical Equipment”
Stairways in good repair with handrails, treads
and risers in proper proportion and non‐slip
Elevated areas have guardrails and toe boards
Work areas, aisle ways, storage areas are orderly
Illumination adequate for normal conditions,
emergency lighting in place
External walking, parking, break areas free of
hazards, well maintained
Warning signs posted for wet floors or spills
Anti‐slip mats and flooring used where
appropriate
Hand Tools Corrective Team Member

Power tools properly grounded/have safety
power switch
Defective tools are removed from service
Proper guards are provided, tools electrically
grounded or double insulated
Preventive maintenance/inspection program
inplace
Employees are trained in the safe use of hand
tools
Machinery Corrective Team Member

Lockout/tagout program in place, locks available,
employees trained
Hazardous areas painted bright colors
Guards are provided for “point‐of‐operation” of
machinery.
Clothing and hair restrictions in place to prevent
entanglement in machinery
Power transmission guards are in place
Noise exposures adequately addressed
Warnings displayed in obvious locations
Compressed air systems have pressure reduced to
30 PSI and are not used for cleaning clothing
Air hoses provided with safety latch to prevent
accidental disconnect
Welding equipment in good condition
Compressed gas cylinders are and secured to
prevent falling
Overhead hazards from equipment, conveyors,
and process pipes, are guarded below 7 ft from
floor
Mechanical & Manual Materials Handling & Storage Corrective Team Member
Hoist chains, cables, and slings are inspected
regularly and documented
Storage piles are stable and secured from falling
or collapse
Load limits are posted for all floors above ground
level
Load limits are displayed on all hoists
Manual handling aids available and used
Weight limits set for manual lifting, carrying,
pushing, pulling
Workers trained in proper lifting
techniques/ergonomics
Chemicals Corrective Team Member

Hazardous materials containers labeled
MSDS available
Hazard Communication Training program in place
Smoking and eating prohibited in work areas
where chemicals are used
Eyewash/emergency shower available and
functional
Personal Protective Equipment Corrective Team Member

PPE assessment performed – PPE requirements in
place
Employees trained in the use and maintenance of
PPE – training documented
Hard hat areas designated and enforced
Hearing protecting utilized in required areas
Face/eye protection in place where needed
Safety foot protection required where appropriate
Protective clothing, gloves, aprons, boots, face
shields, and goggles are used
when handling hazardous materials
Approved respiratory protection equipment
available and fit tested
Fire Protection Corrective Team Member

Is there an automatic fire detection system?
If Yes, What Type?
Direct to Fire and Police
Local ‐ within the building
Central System Monitor

Automatic sprinklers or standpipes and hoses are
inspected annually
Fire detection system or smoke alarm system in
the building
Fire detection system serviced and inspected

regularly
Fire extinguishers inspected and recharged
annually
Approved safety containers are used for
flammable liquids
Bonding and grounding used with storage of
flammable materials
Combustible debris disposed of regularly
No Smoking” areas designated
Sprinkler system
functional/inspected/documented
Smoke/heat detectors functional and inspected
Minimum 18” clearance below sprinkler heads
Sprinkler valves locked open
Electrical Corrective Team Member

Panel boards, switches and fuses enclosed in
metal cabinets that securely close
Circuits easily assessable & identifiable
Are all fuses or breakers properly sized for
equipment and lighting
Recurring problems with fuses or circuit breakers
that are continually tripped
Ground fault interrupters utilized in potentially
wet or damp areas
Machinery and equipment are grounded
Electrical panels clearly marked
Permanent wiring in place – no extension cords
Exposure of overhead electrical lines controlled
Outlets, switches and boxes have covers
Emergency stops and critical electrical controls
are identified
Appropriate electrical systems designed for
hazardous locations have been
installed in spray booths and flammable liquid
storage rooms
HVAC Corrective Team Member

HVAC system been inspected and serviced within
the past year
Is an outside service contractor
Boiler’s low water cutoff/water supply flushed out
every month during the heating season
Boiler room meet fire code requirements
concerning non‐combustible materials and proper
fire‐related doors and closers
Boiler room properly ventilated
No combustible materials are stored in the Boiler
room
Vents and chimney flutes inspected for clear
passage annually
Do you have a program for cleaning ductwork and
diffusers
Risk Assessment conducted by: _________________________________ Date:___________________________

(Business staff)
It is recommended that you update or review this questionnaire periodically. When you have this document competed,
please fax it to ServiceMaster Anytime at 805‐456‐0457. We will retain your facility information in our Emergency Services
Data base. This information is for internal use only and will never be sold or shared. Make a copy of this document and
return to your Emergency Procedures Manual

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Facility Risk Assessment Questionnaire

Business Name: _____________________________ Address:______________________________

City: ______________________ State: __________ Zip: __________________________________

Phone #1:____________ Back Up Phone #:______________ Key Contact: ___________________

Janitorial Service Provider: _____________________ Janitorial Contact Phone______________

Administrative Corrective Team Member

Exits, Walkways and Stairwells Corrective Team Member

Trip/Slip and Fall Hazards Corrective Team Member

Hand Tools Corrective Team Member

Machinery Corrective Team Member

Chemicals Corrective Team Member

Personal Protective Equipment Corrective Team Member

Fire Protection Corrective Team Member

Direct to Fire and Police

Local ‐ within the building

Central System Monitor

Fire detection system serviced and inspected

Electrical Corrective Team Member

HVAC Corrective Team Member

Risk Assessment conducted by: _________________________________ Date:___________________________

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Business Name: _ Address:__

City: State: Zip: ______________

Phone #1: Back Up Phone #: Key Contact: _________

Janitorial Service Provider: _______ Janitorial Contact Phone

Risk Assessment conducted by: _______ Date:_