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# DLA Official Forms

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| Form Number:  DLA7016                                                                                                                                                                                                                                                   |
|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Form Title:  DLA Annual Safety and Occupational Health (SOH) Industrial Workplace Inspection Checklist                                                                                                                                                                  |
| Form Version:  Jun 2018                                                                                                                                                                                                                                                 |
| Status:  Active                                                                                                                                                                                                                                                         |
| Functional Area:  Chief of Staff                                                                                                                                                                                                                                        |
| Opr:  CoS                                                                                                                                                                                                                                                               |
| Safeguards:  none                                                                                                                                                                                                                                                       |
| Electronic:  Yes                                                                                                                                                                                                                                                        |
| Form Link:  Documents/FormsSite/forms/DL7016.pdf                                                                                                                                                                                                                        |
| Type:  Primary                                                                                                                                                                                                                                                          |
| Prescribed:   DLAI 6055.01                                                                                                                                                                                                                                              |
| Description:  To provide a consistent approach for reviewing safety programs and identifying workplace hazards for safety professionals conducting annual safety and health inspections across the Agency. For use by SOH Professionals - i.e., 0018, 0019, 0690, etc.. |
| 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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