Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

Housekeeping Safety

  • The work area is clean and organized.

  • There are no trip hazards.

  • Material is not leaning against the wall.

  • Floor is not icy.

Evacuation

  • Emergency exit routes are clear.

  • Exit doors are clear.

  • Exit doors have signs.

  • Emergency lighting is working.

Fire Prevention

  • Fire extinguishers are not blocked.

  • Fire extinguishers are hanging on the wall.

  • Fire extinguishers have proper identification.

  • Fire extinguisher have been inspected by an outside company.

Eyewash Station

  • The eyewash station is clean, not blocked, and ready for use.

Machine Guards

  • Warning decals and stickers are legible.

  • Rotating parts are guarded to prevent contact.

  • Safety interlocks are working correctly.

  • E-stops are working working correctly.

Lockout Tagout

  • Lockout Tagout equipment is available to authorized employees.

  • Equipment that was "Lockout" at the time of the audit was labeled correctly.

Personal Protective Equipment

  • Personal protective equipment is being provided by the company.

  • There are clear signs to indicate what type of PPE is required to be worn in the department.

  • Gloves are being used as required.

  • Hearing protection is being worn as required.

  • Slip resistant footwear is being worn as required.

  • Safety goggles are being worn when liquid chemicals are being used.

Fall Protection

  • Work platforms that are 4ft high have railings to provide fall protection.

  • Employees are wearing fall protection when working at heights greater than 4ft.

  • Platforms have gates or safety chains to guard the entry location.

Electrical

  • Flexible cords are not running through walls, windows, or doorways.

  • Electrical plugs have covers as needed.

  • Electrical boxes are not blocked.

  • There are no missing knockouts or exposed electrical parts.

  • Flexible cords are not frayed or damaged.

  • There are no electrical cords run through water or across damp floors.

  • Electrical cords are not tied around metal supports.

Chemicals

  • Chemicals are labeled correctly.

  • There are no food or drinks near chemicals.

  • Chemicals are stored correctly.

Additional Information

  • There are no other safety issues that need to be address.

  • Were there positive safety items that need to be spotlighted.

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.