Title Page

  • Document No.

  • Conducted on

  • Prepared by

  • Location
  • Personnel

General Housekeeping

  • Floors free of debris? No storage on floors as to create a trip hazard?

  • No oil, grease or water on floors?

  • Aisles & exits unobstructed?

  • Workbenches clean and neat?

  • Chemical fume hoods clean and neat?

  • No heavy materials (e.g. carboys, equipment, etc.) stored on high shelves and well organized?

Fire Protection / Safety Equipment

  • Is access to emergency response items unobstructed? (e.g. safety shower, eyewash station, fire extinguisher, emergency exit, electrical panel and circuit breaker)?

  • Portable fire extinguishers identified / wall mounted and inspected monthly?

  • Fume hoods operating properly and on annual PM?

  • Evacuation routes posted / updated?

  • Pull fire alarm station should not be obstructed?

Hazardous Chemicals

  • Solvents stored in flammable storage cabinets or vented cabinets under fume hoods?

  • Acids and bases stored in corrosive cabinets?

  • Corrosive, toxic and flammable chemical groups properly segregated?

  • Chemical containers labeled? No expired material allowed?

  • All work with open flammable, corrosive and toxic chemicals are done in fume hoods?

  • Safety Data Sheets (SDS's) documents need to be accessible and employees need to know where to find SDS's?

Electrical Safety

  • No opened or uncovered junction boxes?

  • No frayed or exposed wiring?

  • No extension cords used as to create a tripping hazard?

  • Electrical panels not blocked? Panels identified? No exposed cables?

  • Electrical panels and controls are clearly identified?

Personal Protective Equipment

  • Eye protection used where or when required? (e.g. clean room, sub-assembly)?

  • Face protection used where or when required. (e.g. Etching, microfinish, machine shop, chemical mixing)?

  • Proper gloves used when handling materials or chemical?

  • Respirators used when required (e.g. Reel to Reel, chemical mixing)?

  • Aprons and gowns used where or when required (e.g. Etching, microfinish, reel to reel, chemical mixing)?

Machine Guarding

  • Machines have guards to protect employees from their hazards?

  • All guards are installed and no by-pass is observed?

  • All moving parts are protected with guards?


  • Waste containers for sharps available and identified?

  • Recycling containers available and identified?

  • Spill control materials available in the area and identified?

  • Alcohol wipes should be discarded always in red containers?

  • Red containers should have the hazardous waste labels and the open/close spring needs to be functional?


  • Do job tasks require repeated or prolonged raising of the hands above the shoulder?

  • Do job tasks create pressure points between any parts of the body and the workstation or tool service (wrists, forearms, back, or thighs)?

  • Can employees comfortably see their work without straining?

  • Operator exposed to equipment vibrations?

  • Are work materials ergonomically positioned for safe lifting?


  • Print Name

  • Signature

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