Title Page
-
Department
-
Conducted on
-
Prepared by
Electrical Safety Observations
-
Panels Clear of Obstructions
-
Panels Blocked
-
Electrical doors closed
-
Electrical Equipment Free of Damage
-
Electrical Equipment Damaged
-
Voltage Labels on Electrical Boxes
-
Voltage Labels on Electrical Boxes MISSING
-
Arc Flash Labels on Electrical Boxes
-
Arc Flash Labels on Electrical Boxes MISSING
-
Exit Lights Good Working Order
-
Exit Lights Not Working
-
Emergency Lights Clean
-
Emergency Light not Clean
General Safety
-
Forklift and other Mobile Equipment Inspections Completed
-
Forklift and other Mobile Equipment Inspections NOT Completed
-
Fire Equipment Accessible
-
Fire Equipment NOT Accessible
-
Chemicals Properly Labeled
-
Chemicals MISSING Labels
-
Employees Wearing Safety Glasses
-
Employees NOT Wearing Safety Glasses
-
Employees Wearing Hearing Protection
-
Employees NOT Wearing Hearing Protection
-
Employees Wearing Proper Gloves/Hand Protection
-
Employees NOT Wearing Proper Gloves/Hand Protection
-
Employees wearing Reflective Shirts or Vest
-
Employees NOT wearing Reflective Shirts or Vest
-
Tools in Good Condition
-
Tools Broken or Improperly Modified
Housekeeping
-
Aisles are clear of Obstacles
-
Aisles are BLOCKED
-
Gas Cylinders Properly Stored
-
Gas Cylinders are NOT Properly Stored
-
All Drinking Container Tops are Properly Closed
-
Open Top Drinks or Food in Found in the Work Areas