Title Page

  • Site conducted


  • Conducted on

  • Prepared by

  • Location



  • Are all worksites clean and orderly

  • Are work surface kept dry or appropriate means taken to assure the surface are slip resistant

  • Are all spilled materials or cleaned up immediately

  • Are combustible scrap,debris,and waste stored safely and removed from the worksites promptly

  • Is accumulated combustible dust routinely removed from elevated surfaces including the overhead structure of building?

  • Is combustible dust cleaned up with a vacuum system to prevent the dust going into suspension

  • Is metalic or conductive dust prevented from entering or accumulation on or around electrical enclosures or equipment?

  • Are covered metal waste cans used for oily and paint-soaked waste?

  • Are all oil and gas fired devices equipped with flame failure controls that will prevent the flow of fuel if pilots or main burners are not working

  • Are paint spray booths dip tanks and the like cleaned regularly?

  • Are all work areas adequately illuminated

  • Are the minimum number of toilets and washing facilities provided

  • Are all toilets and washing facilities clean and sanitary

  • Are pits and floor openings covered or otherwise guarded


  • Do employees who operate vehicles on public thoroughfares have valid operators licenses?

  • When seven or more employees are regularly transported in a van, bus or truck, is the operators license appropriate for the class of vehicle being driven?

  • Is each van,bus or truck used regularly to transport employees, equipped with an adequate number of seats?

  • When employees are transported by truck,are provision provided to prevent their falling from the vehicle?

  • Are vehicles used to transport employees, equipped with lamps,brakes,horns, mirrors, windshield and turn signals in good repair?

  • Are transport vehicles provided with hardrails,steps,stirrups or similar devices,so placed and arranged that employees can safely mount or dismount?

  • Are employee transport vehicles equipped at all times with at least two refelective type flares?

  • Is a full charged fire extinguisher, in good condition,with at least 4 B:C rating mainted in each employee transport vehicle?

  • When cutting tools with sharp edges are carried in passenger compartments of employee transport vehicles,are they placed in closed boxes or containers which are secured in place?


  • Can the work be performed without eye strain or glare to the employees?

  • Does the task require prolonged raising of the arms?

  • Do the neck and shoulders have to be stooped to view the task?

  • Are there pressure points on any parts of the body (wrists,forearms,back of thighs)?

  • Can the work be done using the larger muscles of the body?

  • Can the work be done without twisting or overly bending the lower back?

  • Are there sufficient rest breaks,in addition to the regular rest breaks,to relieve stress from repetitive- motion tasks?

  • Are tools, instruments and machinery shaped, positioned and handled so that tasks can be performed comfortably?

  • Are all pieces of furniture adjusted positioned and arranged to minimize strain of all parts of body?

  • Can the work be performed without high strain or glare to the employees?


  • Does your HVAC system provide atleast the quantity of outdoor air required by the state building standerd?

  • Is the HVAC system inspected atleast annually and problem corrected?

  • Are inspection record retained for atleast 5 years?


  • Are protective goggles or face shields provided and worn where there is any danger of flying particles or corrosive material?

  • Are approved safety glasses required to be worn at all times in areas where there is a risk of eye injures such as punctures, abrasion,contusions or burns?

  • Are hard hats provided and worn where danger of falling objects exists ?

  • Are protective gloves,aprons, shields,or other means provided against cuts,corrosive liquids and chemical?

  • Are hard hats inspected periodically for damage to the shell and suspension system?

  • Is appropriate foot protection required where there is the risk of foot injuries from hot, corrosive,poisonous substance,falling objects,crushing or penetrating actions?

  • Are approved respirators provided for regular or emergency use where needed?

  • Is all protective equipment maintained in a sanitary condition and ready for use?

  • Where special equipment is needed for electrical workers is it available?

  • When lunches are eaten on the premises are they eaten in areas where there is no exposure to toxic materials or other health hazards?

  • Is protection against the effects of occupational noise exposure provided when sound levels exceed those of the CAL/OSHA noise standard?


  • Are all tools and equipment (both company and employee- owned) used by employees at their workshops in good condition?

  • Are hand tools such as chisels,punches, which develop mushroomed heads during use recondioned or replaced as necessary?

  • Are broken or fractured handles on hammers axes and similar equipment replaced promptly?

  • Are worn or bent wrenches replaced regularly?

  • Are appropriate handles used on files and similar tools?

  • Are appropriate safety glasses,face shields,and similar equipment used while using hand tools or equipment that might produce flying materials or be subject to breakage?

  • Are jacks checked periodically to assure they are in good operating condition?

  • Are tool handles wedged tightly in the head of all tools?

  • Are tool cutting edges kept sharp so the tool will move smoothly without binding or skipping?

  • Are tools stored in dry, secure location where they won't be tampered with?


  • Are grinders,saws,and similar equipment provided with appropriate safety guards?

  • Are power tools used with the correct shield, guard or attachment recommended by the manufacturer?

  • Are portable circular saws equipped with guards above and below the base shoe?

  • Are circular saw guards checked to assure they are not wedged up, thus leaving the lower portion of the blade unguareded?

  • Are rotating or moving parts of equipment guarded to prevent physical contact?

  • Are all cord- connected, electrically operated tools and equipment effectively grounded or of the approved double insulated type?

  • Are effective guards in place over belts,pulleys,chains,and sprockets,on equipment such as concrete mixers,air compressors,and the like?

  • Are portable fans provided with full guards or screens having opening 1/2 inch or less?

  • Is hoisting equipment available and used for lifting heavy objects,and are hoist ratings and characteristics appropriate for the task?

  • Are ground-fault circuit interrupters provided on all temporary electricals 15 and 20 ampere circuits, used during periods of construction?


  • Is the work rest used and kept adjusted to within 1/8 inch of the wheel?

  • Is the adjustable tongue on the top side of the grinder used and kept adjusted to within 1/4 inch of the wheel?

  • Are bench and pedestal grinders permanently mounted?

  • Are goggles or face shields always worn when grinding?

  • Does each grinder have an individual on and off control switch?

  • Is each electrically operated grinder effectively grounded?

  • Before new abrassive wheels are mounted are they visually inspected and ring tested?

  • Are dust collectors and powered exhausts provided on grinders used in operations that produce large amounts of dust?

  • Are splashguards mounted on grinders that use coolent to prevent the coolent reaching employees?

  • Is cleanliness maintained around grinders?


  • Are only authorised and trained personnel permitted to use welding cutting or brazing equipment?

  • Do all operator have a copy of the appropriate operating instructions and are they directed to follow them?

  • Are compressed gas cylinders regularly examined for obvious signs of defects deep rusting or leakage?

  • Is care used in handeling and storage of cylinders safety valves relief valves and the like to prevent damage?

  • Are cylinders kept away from sources of heat?

  • Is it prohibited to use cylinders as rollers or supports?

  • Are empty cylinders appropriately marked their valves closed and valves protection caps on?

  • Are signs reading:DANGER NO-SMOKING,MATCHES OR OPEN LIGHTS OR the equivalent posted?

  • Are cylinders, cylinder valve,coupling regulator hoses and apparatus keep free of oily or greesy substances?

  • Are liquefied gases stored and shipped valve end up with valve covers in place?

  • Are pressure reducing regulators used only for the gas and pressures for which they are intended?

  • Under wet conditions are automatic controls for reducing no load voltage used?

  • Are electrodes removed from the holders when not in use?

  • Is suitable fire extinguisher equipment available for immediate use?

  • Are wet machines thoroughly dried and tested before being used?

  • Is the welder forbidden to coil or loop welding electrode cables around his body?


  • Are only trained personnel allowed to operate industrial trucks?

  • Is substantial overhead protective equipment provided on high lift rider equipment?

  • Are the required lift truck operating rules posted and enforced?

  • Is directional lighting provided on each industrial truck that operates in an area with less than 2 foot candles per square foot of general lighting?

  • Does each industrial truck have a warming horn,whistle,gong or other device which can be clearly heard above the normal noise in the areas where operated?

  • Are the brakes on each industrial truck capable of bringing the vehicle to a complete and safe stop when fully loaded?

  • Will the industrial trucks parking brake effectively prevent the vehicle from moving when unattended ?

  • Are industrial trucks operating in areas where flammable gases or vapors or combustible dust or ignitable fibers may be present in the atmosphere approved for such locations?


  • Are all work areas properly illuminated?

  • Are employees instructed in proper first aid and other emergency?

  • Are hazardous substances identified which may cause harm by inhalation, ingestion,skin absorption or contact?

  • Is employees aware of the hazards involved with the various chemicals they may be exposed to in their work environment such as ammonia,chlorine,expoxies and caustics?

  • Is employee exposure to chemicals in the workplace kept within acceptable levels?

  • Can a less harmful method or product be used?

  • Is the work area's ventilation system appropriate for the work being performed?

  • Is employee exposure to welding fumes controlled by ventilation use of respirators exposure time or other means?

  • Are welders and other workers nearby provided with flash shields during welding operations?

  • Has there been a determination that noise levels in the facilities are within acceptable levels?

  • Are steps being taken to use enginnering controls to reduce excessive noise levels?

  • Are caution lebels and signs used to warn of asbestos?

  • Is vacuuming with appropriate equipment used whenever possible rather then blowing or sweeping dust?

  • Is personal protective equipment provided used and maintained wherever required?

  • Are restrooms and washrooms kept clean and sanitary?

  • Is all water provided for drinking,washing and cooking potable ?

  • Are all outlets for water not suitable for drinking clearly identified?

  • Are employees instructed in the proper manner of lifting heavy objects?

  • Is equipment producing ultra- voilet radiation properly shielded?


  • Do you have a fire prevention plan?

  • Does your plan describe the type of fire protection equipment and/ or systems?

  • Have you established practices and procedures to controls potential fire hazards and ignition sources?

  • Are employees aware of the fire hazards of the material and processes to which they are exposed ?

  • If you have a fire department well acquainted with your facilities location and specific hazards?

  • If you have a fire alarm system is it certified as required?

  • If you have a fire alarm system is tested at least annually?

  • Are fire doors and shutters in good operating condition?

  • Are fire door and shutter fusible links in place?

  • Is proper clearance maintained below sprinkler heads?

  • Are fire extinguisher mounted in readily accessible location?

  • Are fire extinguishers recharged regularly and noted on the inspection tag?


  • Are your workplace electricians familiar with the CAL/OSHA electrical safety orders?

  • Do you specify compliance with CAL/OSHA for all contract electrical work?

  • Are portable electrical tools and equipment grounded or of the double insulated type?

  • Are electrical appliances such as vacuum cleaners,polishers,vending machinines grounded?

  • Do extention cords being used have a grounding conductor ?

  • Are multiple plug adapters prohibited?

  • Are flexible cords and cables free of splices or taps?

  • Are all cords cable and raceway connection intact and secure ?

  • Are all disconnecting switches and circuit breakers labeled to indicate their use or equipment served?

  • Are disconnecting means always opened before fuses are replaced ?

  • Are all electricals raceways and enclosures securely fastened in place ?

  • Are provided and maintained about all electrical equipment to permit ready and safe operations and maintenance?

  • Is each motor disconnecting switch or circuit breaker located within sight of the motor control device?

  • Are employees prohibited from working alone on energized lines or equipment over 600 volts?


  • Are there areas in the workplace where continuous noise levels exceed 85 dBA?

  • Are noise levels being measured using a sound level meter or on octave band analyzer and records being kept?

  • Have you tried isolating noisy machinery from the rest of your operation?

  • Have engineering controls been used to reduce excessive noise levels?

  • Where engineering controls are determined not feasible,are administrative controls(i.e. worker rotation) being used to minimize individual employee exposure to noise?

  • Is there an ongoing preventive health program to educate employees in safe levels of noise and exposure,effects of noise on their health, and use of personal protection?

  • Is the training repeated annually for employees exposed to continuous noise above 85 dBA?

  • Have work areas where noise levels make voice communication between employees difficult been identified and posted?

  • Is approved hearing protective equipment (noise attenuating devices) available to every employee working in areas where continuous noise levels exceed 85 dBA?

  • If you use ear protectors, are employees properly fitted and instructed in their use and care?

  • Are employees exposed to continuous noise above 85 dBA given periodic audiometric testing to ensure that you have an effective hearing protection system?


  • Is there safe clearance for equipment through aisles and doorways?

  • Are aisleways designated, permanently marked, and kept clear to allow unhindered passage?

  • Are motorized vehicles and mechanized equipment inspected daily or prior to use?

  • Are vehicles shut off and brakes set prior to loading or unloading?




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