McMaster University
Humanities and Social Sciences Joint Health and Safety Committee
WORK PLACE INSPECTION DEFICIENCIES RECORDING SHEETS
Building /Department/Area Inspected:
Inspection date:
Inspectors Names:
Room Number
Area of concern
Ceiling:
Recommended
Corrective Action
Florescent lights
Flickering
Fix and replace
Light cover
missing,
damaged or
needs cleaning
Replace
Lights burned
out
Replace lights
Mold or mild
Repair
Water damage
Repair
Air intake out
take vents dirty
Have vents cleaned
Review of Hazard and Corrective Action to be taken by Supervisor
Date action was taken
Rooms Number
Area of concern Recommended
Shelving Units
Corrective Action
Air vents falling
out of ceiling
Have vents secured
Objects hanging
from light
fixtures
Other:
Remove objects from
Light fixtures
Shelving unit(s)
need to be
anchored to
walls
Anchor to wall
Shelving Units
Free standing
not attached to
wall
Units need to be
anchored
Shelving units
top heavy with
items
Remove heavy items
from top and place in
bottom shelves
Clean
Review of Hazard and Corrective Action to be taken by Supervisor
Date action was taken
Rooms Number
Area of concern Recommended
Shelving Units
Corrective Action
Items stored to
close to ceiling
Remove so there is
18 inches between
shelving and ceiling
Shelving units
Remove
stacked on top of
each other
Other:
Water damage to
walls
Repair
Water damage
around electrical
outlets
Take immediate action
ensure no electrical
hazard
Thermostat
repaired
falling out of wall
fixture
Internet cable
Repair
outlet falling out
of wall
Metal brackets
strips on walls
are falling off
Secure to wall or
remove
Review of Hazard and Corrective Action to be taken by Supervisor
Date action was taken
Rooms Number
Area of concern Recommended
Walls
Corrective Action
Cracks in walls
Enquire if it is structural
Other:
Obstruction of
door
Remove items that are
obstructing the door
Fire door
obstructed
Remove Obstruction
Other:
floor tiles or
carpet
Remove or repair
Area rug not
secure
Remove or repair
Items stored in
walk areas
Remove
Over load of
Replace power bars
electrical power With adequate outlets
bar
Exposed Wires
Cap off or remove
Review of Hazard and Corrective Action to be taken by Supervisor
Date action was taken
Rooms Number
Area of concern Recommended
Electrical
Corrective Action
Extension cords Replace extension cord t
piggy backing
to fit proper needs of
each other or a
Length or outlets
power bar
Outlets falling
Secure to wall
out of wall
fixture
Window cracked Replace
or broken
No window
coverings
Replace
Office
ergonomics is
unsuitable
Assessment of
office ergonomics
White noise from
Mechanical
device radiator
air conditioner
Air conditioner
not working or
radiator
Items stored on
radiator
Remove items on
radiators to
avoid fire
Review of Hazard and Corrective Action to be taken by Supervisor
Date action was taken
Rooms Number
Area of concern Recommended
Other:
Corrective Action
Poor air quality
in rooms
Review of Hazard and Corrective Action to be taken by Supervisor
Date action was taken
Have EHOSS test air
Other:
Note: Air Vents and filter in all offices should be cleaned once a year to ensure proper air quality, a work order must be submitted to physical
plant, this will be at the cost of the university and not at the cost of the departments.
Instructions to Supervisors:
After completing the Review of Hazard and Corrective Action, please sign the report and return the completed form to the JHSC committee address
listed below:
Chris Hollins hollinc@mcmaster.ca; KTH-135
For high risk hazards marked with an * please take immediate action. Return completed form as soon as possible, but no longer than one week
from receiving this inspection.
Thank you for your cooperation
Co- Chairs:
Nick Marquis marquis@mcmaster.ca
Lynn Holland hollandl@mcmaster.ca (Acting Co-Chair)
I have reviewed the hazard(s) noted above and have recorded the corrective action(s) which have been taken to address these concerns
Supervisor’s Signature:___________________________________________________
Date:________________________________________
Any questions please contact the joint health and safety committee or our web site at:
http://www.socialwork.mcmaster.ca/arts-joint-health-safety-committee
August 2011