This document is a monthly slip, trip, and fall self-inspection checklist for a location. It contains sections to evaluate parking areas, entrances/exits, floors, stockrooms/warehouses, washrooms, and escalator/elevator safety. For each item, inspectors mark it as satisfactory, unsatisfactory, or not applicable. Any unsatisfactory items require corrective comments and follow-up. Completed checklists are filed monthly and retained for two years.

1. Monthly Slip, Trip, and Fall
Self-Inspection
Location Name/Number: _______________________________ Date: _____________
This audit is designed to be performed by members of the management team in conjunction with the monthly safety meeting. When
completing this self-inspection, conditions that are found to be satisfactory should be marked with an "S" to the left of the question.
Unsatisfactory conditions should be marked with a "U" to the left of the question. Questions that do not apply should be marked N/A,
indicating "not applicable." Any conditions found to be "unsatisfactory" require a correction action comment on the deficiencies page and
follow up by management to insure the unsatisfactory condition is corrected as soon as possible. Completed audits should be filed monthly
for review by district or regional management and retained for a period of two years.
S = Satisfactory U = Unsatisfactory N/A-Not Applicable
SECTION I - PARKING AREA/SIDEWALKS
Date: _________________ Completed By: ____________________________________
S/U
______ A) Surface Condition - pavement unbroken and free of potholes. Areas clear of trash and debris.
______ B) Handicapped parking stalls properly marked/signed.
______ C) Sidewalks in good repair and do not present a tripping hazard.
______ D) All external lighting functioning properly/as designed.
______ E) Leased properties. Landlord or property management notified when unsafe conditions are noted.
(Inadequate snow removal, salting, roof leaking, debris in parking lot or employee parking area, etc.)
SECTION II - ENTRANCES/EXITS
Date: _________________ Completed By: ____________________________________
S/U
______ A) Doorway threshold plates tightly fastened, beveled to prevent trip exposures.
______ B) Emergency evacuation lighting works when tested.
______ C) Exit signs properly illuminated without obstruction of visibility.
______ D) Stairwells are clear of any merchandise, fixtures and trash.
______ E) Approved decals are installed at a level of 4' 6" on all glass doors and partitions to prevent customers from
striking into glass and falling.
SECTION III FLOORS
Date: _________________ Completed By: ____________________________________
S/U
______ A) Platforms/bases that are used for special displays do not represent a tripping hazard.
______ B) Empty platforms/bases are removed from the area.
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2. ______ C) Platforms, bases, displays or stack-outs do not block access to handrails, stairways, etc.
______ D) Rolling equipment is safety striped or painted with bright paint as required.
______ E) Material handling equipment is limited to one unit per associate working to protect customers or the public
from tripping or striking into the equipment.
______ F) Ladders are directly attended and removed from the floor immediately after use.
______ G) Aisles are free of unattended cartons that represent potential tripping
hazards.
______ H) Handrails are installed and secure for all steps with more than two risers.
______ I) Floors free of tripping/slipping hazards. (i.e., trash, debris, fixturing components, extension cords,
unattended ladders or other material handling equipment, etc).
______ J) Entrance mats are used and maintained in a clean and dry condition to prevent slipping hazards. Mats are
placed tight against the door threshold and tight against each other to provide maximum coverage for
customers and employees to rid their shoes of moisture. Entrance mats are of good quality and do not
present a trip hazard.
______ K) Carpeting free of any tears, waves or other defects which are significant and create a tripping hazard.
______ L) Carpet edge molding is securely attached throughout the building and does not present a hazard.
______ M) Spill Kit Requirements - Pop-up paper towels are maintained at designated areas for "quick" pick-ups of
minor spills.
______ N) Complete spill kits are available in designated areas as follows:
Wet Floor Whisk Dust Pan Window Paper Absorbent
Sign Broom Cleaner Towels Materials/Bucket
Designated
Area # 1
Designated
Area # 2
Designated
Area # 3
Designated
Area # 4
Designated
Area # 5
______ O) One dedicated mop, bucket and two wet floor signs are available for response to larger spills.
______ P) Three associates are questioned about the use of spill kits and can confirm their location, contents and use.
S/U Associate Name Title
______ _______________________ ____________________________________
______ _______________________ ____________________________________
______ _______________________ ____________________________________
SECTION IV – STOCKROOMS/WAREHOUSE
Date: _________________ Completed By: ____________________________________
S/U
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3. ______ A) Ladders, portable stairs and lift equipment available and in good condition. All are safety striped.
______ B) "Do not climb fixture!" signs are posted in each stockroom and in the warehouse.
______ C) Aisles clear with adequate lighting and free of tripping hazards.
SECTION V -WASHROOMS
Date: _________________ Completed By: ____________________________________
S/U
______ A) Plumbing fixtures in good condition, free of leaks.
______ B) Floors clean and free of slipping/tripping hazards.
SECTION VI – Escalator/Elevator Safety
Date: _________________ Completed By: ____________________________________
S/U
______ A) Escalator landing plates are secure and screws anchoring plates are flush with the walking surface.
______ B) The speed of the handrail matches the speed of the escalator steps.
______ C) Warning signs are installed on both sides of the Up/Down escalators. Signs communicate- No Strollers, Face
Forward, Use Handrail and Hold Child's Hand while riding.
______ D) Glass paneled escalators are equipped with exterior- side child restraints to prevent children from fitting or
falling between the escalator and the railing.
______E) The escalator start-key is readily accessible.
______F) Elevator functions properly when tested. Carriage is level with the floor when doors open.
______G) Valid Certificates of Inspection are on file or posted as required for escalators and elevators
Corrective Action Comments
Deficiency: Person Responsible Date Corrected
(Specify item or task to be completed)
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Manager Signature: ___________________________________ Date:____________________________
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