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# DLA Official Forms

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Form Information
| 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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