Operations Building Safety Assessment Form
Instructions for Use: Complete all sections of this form accurately and thoroughly to assess the building's safety standards. Assign scores based on the assessment criteria, and provide detailed comments or actions required for scores below 3. Sign and date the form upon completion and submit it to the designated department head for review and follow-up actions.
General Information
Assessment Date | | Building Location | |
Assessor Name | | Department/Unit | |
Assessment Type | |
Assessment Scores
The following criteria are evaluated on a scale of 1 (Poor) to 5 (Excellent). Any criteria marked below 3 requires immediate attention.
Criteria | Score | Comments /
Actions Required |
Structural Integrity Condition of building foundation, walls, floors, and roofs. Presence of cracks or structural damage. Evidence of water damage.
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Fire Safety Availability and accessibility of fire extinguishers. Functionality of smoke detectors and fire alarms. Clarity of fire evacuation routes.
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Electrical Safety Condition and organization of electrical wiring. Functionality of circuit breakers and electrical panels. Availability of emergency power sources.
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Emergency Exits Visibility and accessibility of emergency exits. Adequacy of emergency exit signage and lighting. Obstructions in pathways to emergency exits.
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Lighting Adequacy of lighting in all areas. Functionality of emergency lighting systems. Condition of light fixtures and switches.
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Ventilation and Air Quality Effectiveness of ventilation systems. Presence of any odors or pollutants. Regular maintenance of HVAC systems.
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Sanitation Facilities Cleanliness and availability of restrooms. Supply of sanitary products. Functionality of plumbing systems.
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Accessibility Compliance with accessibility standards for individuals with disabilities. Condition of ramps, lifts, and handrails. Signage for accessible routes and facilities.
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Assessor’s Final Remarks
Follow-up and Review
Action Item | Responsible Person | Deadline |
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[Assessor’s Signature]
[Month Day, Year]
[Month Day, Year]
[Date]
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