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# DLA Official Forms

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| Form Number:  DLA7019                                                                                                                                                                                                                                                                        |
|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Form Title:  DLA Supervisor Office Self Safety Inspection Checklist                                                                                                                                                                                                                          |
| Form Version:  Jun 2018                                                                                                                                                                                                                                                                      |
| Status:  Active                                                                                                                                                                                                                                                                              |
| Functional Area:  Chief of Staff                                                                                                                                                                                                                                                             |
| Opr:  CoS                                                                                                                                                                                                                                                                                    |
| Safeguards:  none                                                                                                                                                                                                                                                                            |
| Electronic:  Yes                                                                                                                                                                                                                                                                             |
| Form Link:  Documents/FormsSite/forms/DL7019.pdf                                                                                                                                                                                                                                             |
| Type:  Primary                                                                                                                                                                                                                                                                               |
| Prescribed:  DLAI 6055.01                                                                                                                                                                                                                                                                    |
| Description:  To provide a consistent approach for supervisors to verify required safety information is posted and to assist in identifying workplace hazards when conducting self safety inspections in administrative/office areas across the Agency. For use by the workplace supervisor. |
| Records Retention:  6000.3 Safety and Health Case Files. Destroy 5 years after all aspects of the case are closed.                                                                                                                                                                           |
| Form Audience:                                                                                                                                                                                                                                                                               |

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