UCSB Office Self-Inspection - Injury and Illness Prevention Program

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1	DFSS - Environmental Health & Safety
2	UCSB SELF-INSPECTION CHECKLIST: OFFICES
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4	Under California law (OSHA Injury and Illness Prevention Program), and UCSB campus policy #5400, campus supervisors are responsible for ensuring regular safety inspections are documented.
5	The list provided may not contain every possible hazard, but is a generalized set of guidelines.
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8	Department/work unit: __________________________________________________________________________________________________________________________________
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10	Building: _____________________________________________________________________ Room: ______________________________________________________
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12	Inspector name: _______________________________________________________________________________________________________________________________________
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14	Inspector email: _____________________________________________________ Inspector phone: _______________________________________________________________
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16	Inspection date:
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19	0.0	REVIEW OF PRIOR ACTION ITEMS
20	Item #	Item	Yes	No	N/A	NOTES (Include Room # and Description)	CORRECTIVE ACTION COMPLETED (date, WO# if applicable)
21	0.1	All previously identified action items have been corrected and noted on the corresponding inspection form.
22	0.2	Previously identified issues are not recurring.
23	*** If issues are recurring, a new corrective action must be opened in each inspection. If issues have recurred more than 3 times, greater action must be taken to prevent the recurrence.
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25	1.0	GENERAL SAFETY
26	Item #	Item	Yes	No	N/A	NOTES (Include Room # and Description)	CORRECTIVE ACTION COMPLETED (date, WO# if applicable)
27	1.1	Supervisor has ensured all employees have received documented safety training per the Employee Training Checklist: Office Safety. This form may be found in the Injury and Illness Prevention Program web-link, under UCSB Health and Safety Binder: https://www.ehs.ucsb.edu/iipp.
28	1.2	Workstations are set up in an ergonomically friendly manner. Contact the EH&S Ergonomics Coordinator if assistance is needed or visit the online UC Learning Center and complete the training titled, "Ergonomics.".
29	1.3	Food items are properly stored in designated food storage areas, and food preparation appliances are clean to discourage infestation of pests.
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31	2.0	EMERGENCY
32	Item #	Item	Yes	No	N/A	NOTES (Include Room # and Description)	CORRECTIVE ACTION COMPLETED (date, WO# if applicable)
33	2.1	The employees are familiar with the location and contents of the nearby Safety Bulletin Board.
34	2.2	Employees are familiar with the location and contents of the nearby Emergency Flip Chart.
35	2.3	Employees are familiar with the location and contents of the green ‘Health and Safety Binder’ and the contents within.
36	2.4	Employees are familiar with the location of the nearby emergency pull station/fire alarm.
37	2.5	Supervisor has ensured all required employee emergency and safety training is documented; including fire alarm, and medical emergency, near miss, first aid kit locations & nearby AED locations.
38	2.6	Employees know all accidents and injuries must be reported to their supervisor/s, and documented through the online incident reporting system.
39	2.7	Is there anything else relating to Emergency Preparedness that needs attention at this time? Please note in the comments.
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41	3.0	FACILITY & HOUSEKEEPING
42	Item #	Item	Yes	No	N/A	NOTES (Include Room # and Description)	CORRECTIVE ACTION COMPLETED (date, WO# if applicable)
43	3.1	Office is cleaned regularly.
44	3.2	Office structure is in good condition.
45	3.3	Heating, ventilation, and air conditioning provide proper air changes, and temperature control.
46	3.4	Lighting is adequate.
47	3.5	ADA accessibility is maintained.
48	3.6	Is there anything else relating to Facility and Housekeeping that needs attention at this time? Please note in the comments.
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50	4.0	WALKWAY, SLIP/TRIP/FALL, AND EVACUATION SAFETY
51	Item #	Item	Yes	No	N/A	NOTES (Include Room # and Description)	CORRECTIVE ACTION COMPLETED (date, WO# if applicable)
52	4.1	Floors are clear of slip/trip/fall hazards.
53	4.2	All walkways and doorways are clear of obstruction. Where employees are protected by the Americans with Disabilities Act (ADA), exit access for aisles must be at least 36 inches (3 feet) wide.
54	4.3	Storage items are stored away from walkways and gathering areas.
55	4.4	Items are stored where they will not create hazard for lifting or tripping.
56	4.5	Foot area under desks clear to avoid a trip/fall hazard. All cords must be kept tidy to avoid fire hazard, possible shock or electrocution, and for general safety.
57	4.6	Is there anything else relating to Walkway, Slip/Trip/Fall and Evacuation that needs attention at this time? Please note in the comments.
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59	5.0	FIRE SAFETY
60	Item #	Item	Yes	No	N/A	NOTES (Include Room # and Description)	CORRECTIVE ACTION COMPLETED (date, WO# if applicable)
61	5.1	A clear path leading up to Fire Extinguishers and electrical panels is maintained, with a minimum of 36” of space in front and under at all times.
62	5.2	Fire extinguishers are clearly identified, mounted on the wall in their designated space.
63	5.3	All staff members have been trained on fire extinguisher use.
64	5.4	Staff members can clearly identify nearest fire extinguisher location if randomly asked.
65	5.5	In areas with a sprinkler system, all items (storage, furniture, etc.) are kept a minimum of 18” away, in all directions, from the sprinkler heads, and 18 inches horizontally from the ceiling, at all times. If no sprinkler system is available, maintain 2 feet from the ceiling at all times.
66	5.6	Loose paper and flammable material coverage of wall space is kept to 20% or less of each wall to avoid a fire hazard.
67	5.7	Flammable objects such as books, paper, and other materials are not in contact with outlets and power bars.
68	5.8	Cooking appliances such as microwaves, toaster ovens, toasters, and other heat generating food preparation devices are stored in designated cooking areas.
69	5.9	Personal space heaters are approved by the department, are UL listed, are placed on the floor and are not placed within 3 feet of combustible materials.
70	5.10	Is there anything else relating to Fire Safety that needs attention at this time? Please note in the comments.
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72	6.0	EARTHQUAKE & FALLING OBJECT PREPAREDNESS
73	Item #	Item	Yes	No	N/A	NOTES (Include Room # and Description)	CORRECTIVE ACTION COMPLETED (date, WO# if applicable)
74	6.1	All furnishings and equipment (book cases, file cabinets and other large items) over 42 inches in height are fastened to a wall or floor in a manner to prevent walking/tipping/falling in an earthquake.
75	6.2	All large, heavy or angular items are stored below 42 inches, or are secured.All shelves and/or storage above 42 inches have a lip or other method to secure items from falling.
76	6.3	When closed, cabinet doors lock into place, and when in use the cabinet doors are clear of obstruction, vertically and horizontally.
77	6.4	Is there anything else relating to Earthquake & Falling Object Preparedness that needs attention at this time? Please note in the comments.
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79	7.0	ELECTRICAL SAFETY
80	Item #	Item	Yes	No	N/A	NOTES (Include Room # and Description)	CORRECTIVE ACTION COMPLETED (date, WO# if applicable)
81	7.1	Power bars, power cords, multi plug adapters and/or extension cords are not stacked together, interconnected, or daisy-chained.
82	7.2	Extension cords are in good condition without damage, splices, or being sharply bent or pinched.
83	7.3	Extension cords are used for temporary applications only. “Temporary” generally refers to a one-time job or with a transient condition. Please have permanent wiring installed for long-term or repetitive needs, or plug the power bar directly into the outlet.
84	7.4	Extension cords are less than 9 feet long, plugged directly into the wall outlet, and do not run through walls, ceilings or doors.
85	7.5	Power cords are kept tidy to avoid fire hazard, possible shock or electrocution, and for general safety.
86	7.6	In the event a power cord or cable must cross an aisle, or other walkway, an ADA-compliant cord guard is provided. Power cords must never be placed under a rug or carpet. If possible, reroute the power cord or cable entirely and get it off the floor.
87	7.7	Electrical panels are clearly identified, and must have a clear path leading up to the panels, and a minimum of 36 minches maintained in front of the panels, at all times for safety and to allow access.
88	7.8	All outlets are in good condition and do not have cracked/missing plates, or signs of electrical charring.
89	7.9	Is there anything else relating to Electrical Safety that needs attention at this time? Please note in the comments.
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94	PRINT NAME				SIGNATURE		DATE
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96	_______/ _______/ ____________
97	DATE SUBMITTED TO EH&S
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