Information

  • Document Number

  • Facility Location
  • Conducted on

  • Prepared by

Overall Safety Awareness

  • Overall Safety Culture in facility - Based on Observations and worker feedback

  • Overall Safety Awareness of the management and workers.

  • Overall Readiness for an OSHA Inspection?

  • Supervisors assist in worksite hazard analysis, ensure physical protections, reinforce training, enforce discipline, and can explain work procedures based on the training provided to them?

  • Managers verify employees are applying their safety training and following procedures?

  • Management follows the rules and usually addresses the safety behavior of others?

  • Visitors, Contractors and Vendors are provided safety rules and procedures while on site.

Injury/Accident Documentation

  • Are Supervisors completing Supervisor Investigation Forms as part of reporting process?

  • Do your employees know who they should report to if they are injured or witness an accident and/or incident.

  • Are available witnesses information being captured i.e. Legal Employee Name, Employee Identification Number & Contact information?

  • Are witness statements being captured?

  • Are the employees personal medical conditions being noted on reports? (i.e. Diabetes, High Blood Pressure, Hepatitis)?

  • Are the injured employees specific jot title captured at the time of incident and/or injury?

  • Are DWC1 Forms being signed by the injured employee?

  • Are all necessary documents signed and dated by the injured employee?

  • If the employee is not able to sign the required documents at time of incident/injury, are they being signed within 24 hours?

  • Are the injured employees complete personal contact information being captured within the incident report (i.e. Full Legal Name, Residence Address, Employee Number, Telephone Number)?

  • Is the exact time of the injury being documented when reported?

  • Is the time & date of the report being documented?

  • Is the injured employees scheduled shift being documented?

  • Is the injured employees scheduled department being documented?

  • Is the type of injury being documented (i.e. Strain, Sprain, Laceration, etc.)?

  • Is the exposure causing the injury captured?

  • Are all body parts injured documented at the time of the incident?

  • Is the level of discomfort (1-10) that the employee is feeling documented?

  • Is the source of the injury being documented on the incident report (i.e. Sewing Machine, Press Machine, Heavy Lifting, etc.)?

  • Are injuries captured within the incident report as either being a specific injury on a specific date, or an injury cumulative over a long period of time?

  • If incidents are cause by an aggravation of a prior personal or work related injury, are dates and sources of that prior injury being documented?

  • If the injury is cause by a machine, is the source causing the injury documented within the incident report?

  • Is the safety device or safety procedure in place prior to the incident documented in the incident report?

  • Are the following elements included in the incident report?<br>1: Events prior to incident<br>2: The incident event<br>3: The resulting injury of the incident

  • Is the initial cause of the accident/incident document (i.e. Equipment Failure, Failure to follow safety procedure, etc.)?

  • Are pictures of the injury taken?

  • Are pictures of the source taken?

  • Are proper emergency procedures in place when an employee faints, experiences major pain and/or blood loss?

  • If unsure whether the injury is industrial, is the medical authorization noting AOE/COE included (Determination of whether an injury is work-related)?

  • Is the injured employee monitored & assisted appropriately until their clinic pick-up arrives?

  • If the employee decides to not seek medical attention, is the required Medical Refusal Form filled out and signed at the time of incident?

General Safety Hazards Observed

  • General Hazards observed that could cause injury? (Unsafe working conditions or unsafe acts)

  • Are there any "Safe Work Procedures" for machinery or work procedures?

Slips, Trips and Falls

  • Do Cords, Hoses and wires present trip hazards?

  • Are any wet/slippery surfaces noticeable?

  • Are guardrails provided for walking/working surfaces above 4ft?

Lockout Tagout

  • Have written Lockout/Tagout procedures been developed for all hazardous equipment/machines?

  • Have employees performing lockout/Tagouts been effectively trained?

  • Is lockout/Tagout being used properly when being performed?

Compressed Air

  • Is compressed air being used for cleaning?

  • Are nozzles on air hoses equipped with safety tips?

  • Are supports provided for mounting air nozzles?

Chemical Information - Right To Know & Globally Harmonized System

  • Are (M)SDS binders provided where chemical are present?

  • Are (M)SDS binders equipped with inventory log of all chemicals present?

  • Is the (M)SDS updated every 12 months (Annually)?

  • Are there chemical safety posters, signs, and/or information posted for employees to review?

  • Are secondary bottles labeled to meet HMIS or GHS Compliance?

  • Do secondary bottles contain pictograms to indicate hazards along with first air and specific hazard warning instructions?

Chemical Handling and Storage

  • Are chemical drums, totes and containers store on spill plates?

  • Are all primary chemical drums, totes and containers labeled properly?

  • Are approved secondary containers labeled properly with the right chemical?

  • Are small chemical containers (1qt+) store in a self-closing flammable cabinet?

  • Are flammable cabinets grounded to prevent static electricity?

  • Are incompatible chemicals store separately? (I.e. flammables from oxidizers)

  • Are chemical containers stored or being handled safely? (I.e. Are chemical containers stored below eye level?)

  • Are hazardous chemical liquids store on lower shelves to prevent chemical splash injury from falling?

Compressed Gas

  • Do you have compressed gas cylinders/tanks stored or used on site?

  • Are oxygen cylinders separated from fuel gas cylinders? (20ft. Distance shall be provided or a minimum of 18" inches above the tallest cylinder?

  • Are compressed gas cylinders/tanks store to prevent properly to prevent tipping or falling?

  • Do you have confined spaces with hazardous conditions? (Holes, Tanks, Vessels, Pits, Space with limited means of entry, etc.)

  • If Yes, is "Permit Required" or Non-Permit Required" confine space sign posted?

Machine Guarding (Areas where machines are used)

  • Are guards firmly secured and not easily removable?

  • Did you observed any removed or damaged machine guards?

  • Are safety sensors, guards, safety switches working properly or bypassed?

  • Are guards preventing workers from reaching under, over, around and/or behind guarded areas?

  • Are pinch points and inward running rollers properly secured?

  • Are Belts, Chains, Gears, Sprockets, Pulleys and Flywheels guarded?

  • Are sewing machines provided with eye and finger guards?

Electrical Safety

  • Do electrical equipment panels and disconnects have a 36" inch radial clearance for emergency access?

  • Are electrical panels, disconnects and breakers labeled as to what they control?

  • Do electrical panels have voltage/amperage labeled outside of the panel?

  • Are there any electrical panels and disconnects or junction boxes with open slots, uncapped conduit, holes, discontinued circuits or uncovered wiring?

  • Is electrical equipment locked and tagged while it is being maintained and/or serviced?

Exits/Egress Systems

  • Are emergency exit lights and illuminated exits in place and operable?

  • Are exit routes and stairwells clear and unobstructed?

  • Are walkways adequately and clearly marked?

  • Are there more than 2 exits readily available in case of an emergency?

Fire Prevention

  • Are there "No Smoking" signs clearly posted near flammable material within 75 feet?

  • Are fire extinguishers inspected monthly, documented and free of obstructions?

  • Is paper, trash and flammable materials stored away from potential fire or combustion hazards?

  • Do employees know where to go (Safe Zone) an invent of a major incident? And do you have a roll call procedures in place?

  • Are evacuation maps clearly posted and updated in a conspicuous place?

  • Are emergency numbers posted and up to date in conspicuous location?

Employee Training

Have Employees been trained on the following?

  • Lockout/Tagout - Affected and Authorized?

  • Emergency Preparedness - What to do in case of a fire, earthquake, chemical spills, etc?

  • Machine Guarding - Machines/Equipment with no moving parts require to be protected with a safety guard and/or barrier to prevent entry.

  • Back Safety - Training for back injury prevention

  • Fire Extinguishers - Proper use of a fire extinguishers in case of a small fire.

  • Blood Borne Pathogens - Training in order to deal with bodily fluids to prevent infection/illness.

  • Electrical Safety and Arch Flash - Electrical equipment safety in order to prevent shock and/or electrocution.

  • Slips, Trips and Falls - Awareness to avoid slips, trips and falls.

  • Forklift and lift safety - Proper usage of forklifts and powered material handling equipment.

  • HAZWOPER Training - Training for workers at chemical storage areas in case of a chemical spill.

Environmental Hazards: Air, Water, Hazardous Waste or Hazmat Violations

  • Observed potential sewer or storm drain pollution?

  • Air Emission Violations Observed (AQMD) - Permits posted on industrial vessels (boilers, air compressors, etc.)

Compliance Postings

  • Is the required labor law posters displayed and updated annually in a conspicuous place?

  • Are signs regarding exits from buildings, room capacity, elevator permits, floor loading, exposure to x-ray, microwave, or other harmful radiation or substances posted where required?

Dock and Warehouse Safety

  • Are open docks with a fall hazard that exceeds 36" inches protected with a guardrail or restraint and warning signage?

  • Are trucks or trailers secured from movement during loading or unloading? (Wheel chocks or a dock restraint system is required and utilized when loading or unloading trailers with forklifts?

  • Are heavy or bulky items secured to prevent from falling on workers?

  • Are pallets in good condition?

  • Are empty pallets stored flat or in a contained area to prevent injury?

  • We're broken or protruding wood or nail found on pallets?

  • Are pallets on edge?

  • Are they storing pallets in large quantities?

  • Are all racks upright over 6 feet secured down to prevent tipping or falling?

  • Is there clearance between automatic sprinklers of 18" inches for items stacked 15 feet or more?

Ladders and Step stools

  • Step stools not used in place of platforms to handle material above shoulder height?

  • Are platform inspected regularly for damage, stability and safe working condition?

  • Are ladders stored safely when not in use to prevent tipping or falling on workers?

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.