Operations Building Safety Assessment Form
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
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Assessment Date |
Building Location |
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Assessor Name |
Department/Unit |
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Assessment Type |
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Assessment Scores
The following criteria are evaluated on a scale of 1 (Poor) to 5 (Excellent). Any criteria marked below 3 requires immediate attention.
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Criteria |
Score |
Comments / |
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Structural Integrity
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Fire Safety
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Electrical Safety
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Emergency Exits
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Lighting
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Ventilation and Air Quality
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Sanitation Facilities
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Accessibility
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Assessor’s Final Remarks
Follow-up and Review
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Action Item |
Responsible Person |
Deadline |
[Assessor’s Signature]
[Month Day, Year]
[Month Day, Year]
[Date]
