Appendix B: COVID-19 Inspections

[This form is only intended to get you started. Review the information available at for additional guidance on what to regularly inspect for, including issues that may be more pertinent to your particular type of workplace. You will need to modify the form accordingly.]

Date: [enter date]
Name of person conducting the inspection: [Joe Murphy, Environmental, Health & Safety]
Work location evaluated: [enter information]

Exposure Controls Status Person Assigned to Correct Date Corrected
Ventilation* (amount of
fresh air and
filtration maximized)
Additional room air

[add any additional controls your workplace is using]

Hand washing facilities
(adequate numbers and supplies)
Disinfecting and hand sanitizing solutions being used according to manufacturer instructions      
[add any additional controls your workplace is using]      
PPE (not shared, available and being worn)      
Face coverings (cleaned
sufficiently often)
Face shields/goggles      
Respiratory protection      
[add any additional controls your workplace is using]      

*Identify and evaluate how to maximize ventilation with outdoor air; the highest level of filtration efficiency compatible with the existing ventilation system; and whether the use of portable or mounted HEPA filtration units, or other air cleaning systems, would reduce the risk of COVID-19 transmission. Review applicable orders and guidance from the State of California and local health departments related to COVID-19 hazards and prevention have been reviewed, including the CDPH Interim Guidance for Ventilation, Filtrations,
and Air Quality in Indoor Environments and information specific to your industry, location, and operations. We maximize the quantity of outside air provided to the extent feasible, except when the United States Environmental Protection Agency (EPA) Air Quality Index is greater than 100 for any pollutant or if opening windows or maximizing outdoor air by other means would cause a hazard to employees, for instance from
excessive heat or cold.