Title Page
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Site conducted
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Date and Time
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Client
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Location
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Activity
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Contact
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Conducted By
I. Postings
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1. Are Required State and Federal Notices Posted?
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2. Forklift 3664 Noticed
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3. Covid -19
II. First Aid and CPR
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1. Is Supervisor/Foreman current with First Aid/CPR? (At least 1 trained worker for every 20 workers)
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Who? Expiration Date:
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2. Are First Aid Kits clean and with all contents?
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3. Is there a procedure for replenishment of first aid materials?
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4. Is the Doctor Letter of Approval of First Aid Contents available?
III. Emergency Evacuation Plan
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1. Is there a written Emergency Evacuation Plan?
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2. Is there maps posted of the facility?
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3. Is there a designated area for gathering in case of an emergency?
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4. Are drill’s being performed on a yearly basis?
IV. In-Door Heat Illness Prevention Plan
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1. Is the Written In-Door Heat Illness Prevention Plan Available at jobsite in English and the language that workers understand?
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2. Is the Heat Illness Prevention Plan Current?
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3. Have the employees been trained on all the measures?
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4. Have the Supervisors/Foreman been trained on all the Cal/Osha Requirements?
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5. Is potable water for drinking dispensed in single use drinking cups or by fountains, and is the water fresh pure, and suitable cool?
V. Hazard Communication
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1. Have all workers been trained on Hazard Communication & SDS’s?
VI. Equipment
Forklift
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1. Are all Forklift Operators current with training?
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2. Are employees conducting daily pre-use inspections on forklifts?
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3. Does the forklift have a sign showing load capacity?
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4. Is there a horn or another warning device?
Aerial Lift’s
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1. Are all aerial Lifts Operators current with training?
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2. Are employees conducting daily pre-use inspections on aerial lifts?
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3. Does the aerial lift have a sign showing load capacity?
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4. Is there a horn or another warning device?
Other Equipment
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1. Are all Operators current with training?
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2. Are employees conducting daily pre-use inspections?
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3. Does the equipment have a sign showing load capacity?
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4. Is there a horn or another warning device?
Other Equipment
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Are all Operators current with training?
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Are employees conducting daily pre-use inspections?
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Does the equipment have a sign showing load capacity?
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Is there a horn or another warning device?
VII. Personal Protective Equipment
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1. Are Employees required to use PPE? (coverall, gloves, eye protection, respirators, ear plugs, etc.)?
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2. Is PPE provided to Employees?
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3. Is PPE being used properly?
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4. Is PPE the correct ANZI approved?
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5. Are multiple sizes of PPE available to fit different workers?
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6. If respirators are used, have workers been fit-tested and trained in the elements of the written Respiratory Protection Program?
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7. Is PPE cleaned, maintained and stored properly?
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8. Have workers using PPE been trained in its proper use?
VIII. House Keeping, Biological Hazards
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1. Are all work areas kept clean and Orderly?
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2. Are work areas kept dry?
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3. Are spilled materials picked up immediately?
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4. Is combustible scrap or debris removed from work area?
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5. Are employees demonstrating good safety practices, If no? please explain
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6. Are there clean eating areas where there is not exposure to toxic substances?
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7. Does the employer have a system for employees to communicate their concerns about safety and health matters without fear of reprisal, including concerns about work practices and the safe use of hazardous materials including pesticides, cleaners, and fertilizers?
IX. Machinery
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1. Are employee’s trained on machine being performed?
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2. Are employee’s trained where emergency shut off switches are located?
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3. Are all pully belts, pinch points, guarded or have protective shields?
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4. Are employee’s dress accordingly to work around machinery?
X. Eye Wash Station
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1. Are eye wash station available?
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2. Are eye wash station kept clean and caps placed?
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3. Are eye wash station readily assemble?
XI. House Keeping
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1. Are all work areas kept organized and orderly?
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2. Are work areas kept dry and wet signs are displayed if water is available?
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3. Are spills materials cleaned up immediately?
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4. Is combustible scrap and/or debris removed from work area promptly?
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5. Are aisle ways or entryways kept unblocked?
XII. Fire Extinguishers
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1. Are fire extinguishers services annually and have been tagged?
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2. Are fire extinguishers inspected monthly and recorded on the tag?
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3. Are fire extinguishers accessible, not blocked and have a sign?
XIII. Safety Sinage
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1. Are safety signs posted where machinery or other tools are used?
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2. Are all exit signs posted on top of door exits?
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3. Are “NO SMOKING” Signs Posted?
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4. Are safety signs posted where PPE is required?
Recomendations
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