Title Page
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Site conducted
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Conducted on
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Member
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Contact
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Location
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Activity
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Supervisor / Foreman
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Employees
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Conducted by
1. 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
2. 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?
3. Emergency Evacuation Plan
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1. Is there a written Emergency Evacuation Plan?
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2. Are 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?
4. 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 2015?
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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?
5. Hazard Communication
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1. Are SDS available?
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2. Have all workers been trained on Hazard Communication & SDS’s?
6. 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?
7. 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?
8. General Safety
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1. Shop work and storage area clean and orderly?
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2. Exits are identified?
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3. Trip hazards have been eliminated?
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4. Stationary machines anchored to the floor?
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5. Working area for machines clear of obstructions?
9. Machinery & Power Tools
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1. Are employee’s trained on machine or tools being performed?
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2. Are employee’s trained where emergency shut off switches are located?
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3. Is bench grinder wheel 1/8 tool rest, ¼ tongue guard?
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4. Are employee’s dress accordingly to work around machinery?
10. 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?
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4. Is eye wash station accessible and cleared 36” from debris?
11. 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?
12. 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 assessable and cleared 36” from debris?
13. Safety Signage
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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?
14. Electrical Safety
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1. Are all breakers panels labeled?
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2. Is breaker panel accessible and cleared 36” from debris?
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3. Are extension cords in good condition (exposed wiring)?
15. Hazardous Waste Disposal
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1. Storage area is identified?
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2. All waste is labeled properly?
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3. Waste is properly segregated?
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4. Secondary containment is used?
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5. Oily rags disposed in metal container?
16. Welding
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1. Oxygen & Octylene cylinders separated at least 25 feet/or 5 feet fire wall?
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2. Are cylinders secured?
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3. Is welding Curtin used when welding?
17. Other Findings
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1. Other Findings
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2. Other Findings
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3. Other Findings
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4. Other Findings
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5. Other Findings
18. Observations
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1. Observation
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2. Observation
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3. Observation
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4. Observation
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5. Observation
