Title Page

  • Document No.

  • Select your location

  • Conducted on

  • Prepared by

  • Location

Fire Protection

Fire Protection

  • Are sprinkler heads unobstructed and free of debris?

  • Are Fire Pull stations unobstructed?

  • Are all walls and ceilings maintained and intact without holes in the walls or ceilings that would allow fire to travel from one area to another?

  • Are unused pallets stored in a designated area and stacked no more than 5ft?

  • Are fire extinguishers marked, mounted, readily accessible and checked monthly?

  • Are all exits clearly marked?

Chemical Storage

Chemical Storage

  • Is there adequate secondary containment for all liquid hazardous chemical containers?

  • Does the secondary containment system have holes or is rusted?

  • A spill containment kit is readily accessible and easy to open?

  • Are chemical containers properly and clearly labeled?

  • Is there eyewash stations in close proximately and working properly.

Racking

Racking

  • All safeguards, clip locks and load locks are in place?

  • All materials and or equipment are placed or located in such a manner that they are stable, fixed or firm and are safe from unexpected movement?

  • Are all racks secured to the floor with bolts?

  • Are the racks free of visible signs of impact damage?

  • Product is stacked neatly and is not sticking out more than 6 inches into the aisle?

Contractor

Contractor Safety

  • Do you have any contractors on-site? (Temporary workers under your supervision do not apply to this section)

  • Has the contractor signed the safety declaration and is his/her certificate of insurance current and on file?

  • Is there a current certificate of insurance on file?

  • Are barricades used during hazardous work performed by a contractor? (i.e. caution tape, cones, guard rail, etc.)

  • Is the contractor using their own equipment to perform their task? (i.e. ladders, powered equipment, tools, etc.) The use of ADI equipment is not permitted?

  • If applicable have the contractor demonstrate how to lockout the equipment they are working on?

HSE / HOS Integration

  • Are HSE Metrics current on all tier boards? (i.e. Behavior Observations, First Aid / Injury information. TCIR)

  • Are Weekly HSE messages posted and current at the tier board?

  • Are Safety visuals adequate? (i.e. Two person lift locations, safe walking lanes, gloves required where applicable, glasses at foam station, etc)

  • Did you observe employees properly using a sharp?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.