Title Page
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Document No.
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Conducted on
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Prepared by
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Location
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Personnel
General Housekeeping
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Floors free of debris? No storage on floors as to create a trip hazard?
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No oil, grease or water on floors?
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Aisles & exits unobstructed?
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Workbenches clean and neat?
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Chemical fume hoods clean and neat?
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No heavy materials (e.g. carboys, equipment, etc.) stored on high shelves and well organized?
Fire Protection / Safety Equipment
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Is access to emergency response items unobstructed? (e.g. safety shower, eyewash station, fire extinguisher, emergency exit, electrical panel and circuit breaker)?
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Portable fire extinguishers identified / wall mounted and inspected monthly?
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Fume hoods operating properly and on annual PM?
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Evacuation routes posted / updated?
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Pull fire alarm station should not be obstructed?
Hazardous Chemicals
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Solvents stored in flammable storage cabinets or vented cabinets under fume hoods?
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Acids and bases stored in corrosive cabinets?
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Corrosive, toxic and flammable chemical groups properly segregated?
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Chemical containers labeled? No expired material allowed?
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All work with open flammable, corrosive and toxic chemicals are done in fume hoods?
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Safety Data Sheets (SDS's) documents need to be accessible and employees need to know where to find SDS's?
Electrical Safety
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No opened or uncovered junction boxes?
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No frayed or exposed wiring?
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No extension cords used as to create a tripping hazard?
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Electrical panels not blocked? Panels identified? No exposed cables?
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Electrical panels and controls are clearly identified?
Personal Protective Equipment
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Eye protection used where or when required? (e.g. clean room, sub-assembly)?
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Face protection used where or when required. (e.g. Etching, microfinish, machine shop, chemical mixing)?
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Proper gloves used when handling materials or chemical?
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Respirators used when required (e.g. Reel to Reel, chemical mixing)?
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Aprons and gowns used where or when required (e.g. Etching, microfinish, reel to reel, chemical mixing)?
Machine Guarding
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Machines have guards to protect employees from their hazards?
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All guards are installed and no by-pass is observed?
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All moving parts are protected with guards?
Environmental
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Waste containers for sharps available and identified?
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Recycling containers available and identified?
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Spill control materials available in the area and identified?
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Alcohol wipes should be discarded always in red containers?
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Red containers should have the hazardous waste labels and the open/close spring needs to be functional?
Ergonomics
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Do job tasks require repeated or prolonged raising of the hands above the shoulder?
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Do job tasks create pressure points between any parts of the body and the workstation or tool service (wrists, forearms, back, or thighs)?
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Can employees comfortably see their work without straining?
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Operator exposed to equipment vibrations?
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Are work materials ergonomically positioned for safe lifting?
Closure
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Print Name
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Signature
