ADI HSE Gemba

• Document No.

• Audit Title

• Conducted on

  Date

• Prepared by

• Location
  Address

HSE Communications and Visuals

• Sustainable Opportunity Policy posted and signed by current manager?

  Yes

  No

  N/A

• Tier Board - HSE Cross updated and Behavior targets measured?

  Yes

  No

  N/A

• Tier Board - Safety Messages Current?

  Yes

  No

  N/A

• Evacuation Maps Posted?

  Yes

  No

  N/A

• Heavy Item (2 Man lift, etc) visuals posted where applicable?

  Yes

  No

  N/A

• Rack Load Limits posted?

  Yes

  No

  N/A

• Min / Max stacking heights visuals adequate?

  Yes

  No

  N/A

• PPE Visuals adequate?

  Yes

  No

  N/A

• Exit Signage visible?

  Yes

  No

  N/A

Gemba Conditions

• Means of escape adequate and clear from obstruction (min 36")?

  Yes

  No

  N/A

• Extinguishers in date, charged (check gauge for green), not blocked or damaged?

  Yes

  No

  N/A

• Are first aid kit checked? (Insp tag and Exp dates)

  Yes

  No

  N/A

• Is the lighting adequate for the workspaces? Leave suggestions where there are darker areas

  Yes

  No

  N/A

• Piping - free of leaks, adequately marked, not damaged?

  Yes

  No

  N/A

• Are electrical cables / plugs / wires / sockets in good condition and secured to prevent tripping?

  Yes

  No

  N/A

• Blind corners - adequate signage, mirrors, etc present?

  Yes

  No

  N/A

• Are workstations clean and free from dust?

  Yes

  No

  N/A

• Is product stacked in safely? (no leaning, orderly, stretch wrapped at higher levels) Include pallets and wastes

  Yes

  No

  N/A

• Employee break areas clean with schedule followed?

  Yes

  No

  N/A

• Are Smoking areas clean and signage?

  Yes

  No

  N/A

• Are pedestrian walking areas / no storage clearly marked?

  Yes

  No

  N/A

• Flammable cabinets - contents orderly, chemicals labeled, no leaks present, no combustibles such as paper/cardboard

  Yes

  No

  N/A

• Waste Battery Collection - ends covered, container in good condition, log of shipments available?#Gemba Behaviors

  Yes

  No

  N/A

• Lift truck operation - speed, horn, vision, lifting at heights, parking break when away, forks lowered, daily inspection

  Yes

  No

  N/A

• Emergency response - ask where to shelter, evacuation meeting area, last drill completed

  Yes

  No

  N/A

• Ergonomics - observe lifting by bending at knee, minimal twisting, balanced, planned properly, weights lifting, etc

  Yes

  No

  N/A

• Stacking / storing - keeping order, correcting out of standard quickly, items at optimal height and locations

  Yes

  No

  N/A

• PPE and Use of Sharp - safety shoes worn, gloves when handling pallets, cutting away from body, retractable or covered blade, glasses with foam machine

  Yes

  No

  N/A

• Employee interview - how to report injury or unsafe condition, what is the biggest risk, what is safe about the environment, last safety message topic

  Yes

  No

  N/A

Gemba Behaviors

• Lift truck operation - speed, horn, vision, lifting at heights, parking break when away, forks lowered, daily inspection

  Safe

  At Risk

  N/A

• Emergency response - ask where to shelter, evacuation meeting area, last drill completed

  Safe

  At Risk

  N/A

• Ergonomics - observe lifting by bending at knee, minimal twisting, balanced, planned properly, weights lifting, etc

  Safe

  At Risk

  N/A

• Stacking / storing - keeping order, correcting out of standard quickly, items at optimal height and locations

  Safe

  At Risk

  N/A

• PPE and Use of Sharp - safety shoes worn, gloves when handling pallets, cutting away from body, retractable or covered blade, glasses with foam machine

  Safe

  At Risk

  N/A

• Employee interview - how to report injury or unsafe condition, what is the biggest risk, what is safe about the environment, last safety message topic

  Safe

  At Risk

  N/A