Title Page

  • Conducted on

  • Prepared by

  • Location

AREA

  • Department/Areas Reviewed:

  • * If issues cannot be imediately corrected, move item to tier board for escalation

Ergonomics

  • The highest ergonomic risk in your area has been identified, being addressed or is there a status on a Tier Board?

  • if No, list corrective actions

  • Are the status of ergonomics improvements communicated to all Team Members in the area?

  • if No, list corrective actions

  • Can Team Members identify ergonomic risks in their work area ? Are these on the ESI team's list for improvements?

  • if No, list corrective actions

  • Are Team Members familiar with the ergonomic hit list? Have they had ergonomic awareness training within the last 2 years?

  • if No, list corrective actions

Exposure Monitoring

  • Are chemical and/or dust concerns raised by Team Members being addressed?

  • if No, list corrective actions

  • Have new chemicals that have been introduced into work area had exposure monitoring completed on them at point of use?

  • if No, list corrective actions

  • Are there new pieces of machines in the area that have increased the noise levels? If yes, have sound levels and personal dosimetry been done to assess exposure levels?

  • if No, list corrective actions

Physical Hazards

  • Is lighting level adequate for the tasks team members?

  • if No, list corrective actions

  • Are machines that generate dust set up to control the spread of debris/dust?

  • if No, list corrective actions

  • Are machines with hot surfaces properly labeled and if feasible guarded and/or barricaded to prevent accidental contact?

  • if No, list corrective actions

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.