HR Safety Inspection Template

HR SAFETY INSPECTION TEMPLATE

Inspection Details

Company Name:

Location/Facility:

Department/Area:    Date of Inspection:    Time:

Inspector Name:    Title:

Inspector Contact:

Personnel Information

Position Information

Reporting Manager:    Start Date:    Salary/Rate:

Inspection Checklist (Mark applicable and provide comments)

  Housekeeping and housekeeping hazards present
Comments:

  Fire safety equipment accessible and functional
Comments:

  Electrical hazards (wiring, outlets, cords)
Comments:

  Machine guarding and lockout/tagout compliance
Comments:

  Personal protective equipment availability and use
Comments:

Observations & Findings

Corrective Actions & Follow-Up

Action Item 1:

Priority: High   Medium   Low

Responsible Person:    Target Completion Date:

Action Item 2:

Priority: High   Medium   Low

Responsible Person:    Target Completion Date:

Action Item 3:

Priority: High   Medium   Low

Responsible Person:    Target Completion Date:

Employment History (Personnel Involved)

Employer 1

From:    To:

Employer 2

From:    To:

Education

Graduation Date:

References (Professional)

Reference 1

Reference 2

Reference 3

Legal Disclosures & Authorizations

At-Will Employment Statement: Employment status and any corrective action referenced in this inspection are administered pursuant to the employer's at-will employment policies unless otherwise defined by a written employment agreement executed by authorized representatives.

Equal Opportunity Statement: The company prohibits discrimination and provides equal employment opportunity in all employment practices without regard to protected characteristics as required by law.

Certification: I certify under penalty of administrative discipline that the information contained in this inspection report is true and accurate to the best of my knowledge. I acknowledge that falsification of inspection findings or corrective action records may result in disciplinary measures.

Authorization to Contact and Background Checks: By signing below, relevant personnel authorize the employer to contact prior employers and references listed for the purposes of verifying employment history and safety compliance records. Where permitted by law, this authorization also permits the employer to obtain background checks, safety incident records, or regulatory compliance information necessary to the safety review. Check to acknowledge:
  I authorize contact with prior employers and consent to background or safety record checks where required for employment or safety investigation purposes.

Applicant / Personnel Certification

I certify that all information provided in this form is true and complete. I understand that omissions or misrepresentations may be cause for disciplinary action, up to and including termination. I agree to cooperate with corrective action plans identified in this inspection and to participate in follow-up verification as required.
  I certify that the information provided is true and complete.

Sign Now