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inspection Lacatiorr {s): <br />Depai tment/Areas Covered: <br />Item <br />(and location) <br />—Corr` b <br />Hazards <br />Observed <br />WORKPLACE INSPECTION RECORDING FORM <br />1,v k C. Ce n EDate nspection: I p : <br />m� nspection : . 12 Jag <br />sR :F_a t.aW tip .. <br />Hazard Repeat Recommended Action BY Actlon Taken Cate Authorized <br />Class Item Completed Signature <br />(see <br />below) Yes No Whom When <br />Copies To (For Action): �Ct�1�{,r,�r-� Inspect By: <br />Copies To'(For Inform ation), t { rS pdrrti' r1 IL i�r -►ter. U e <br />Class "A" Hazard: A cancition or practice with the potential for permanent disability, loss of <br />material. life or body part, andi'or extensive Was of structure, equipment or <br />Class "6" Hazard: A condition or practice with the potential for serious Injury or Illness (resulting In serious or temporary disability) or property damage that is <br />dlsrWUYe but less so than Class "A°. <br />Class "C° Hazard: A condition or practice with the potential for Injury or illness, or disruptive (non-disabling) properly- damage. : <br />0 tndustid Aoident Prevention AssWalion. 2002. 1-800406 1APA (4272) - www.iapa.on.ca <br />