Information
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Work area observation
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Uniform: appearance, USafe logo
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Posters: Usafe
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Equipment: Electrical powered tools
Walking & working surfaces
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Floor care: wet floor signs in use
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Ladders: proper set-up and usage
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Proper footwear for job task
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Slips, Trips & Fall hazards
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Disposal area: compactors, dumpsters, etc.
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Sanitary Drainage Availability - Slop sinks, floor drains
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Eye wash/Showers: Battery charging, corrosive chemical exposure (stripping solution)
Personal Protective Equipment
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Eye/face protection: safety glasses, goggles, face shield
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Hand protection: Disposable gloves, Chemical resistant gloves, winterized gloves
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Foot protection: slip resistant shoes, company supplied boots when stripping floors, stableicers for winter wear
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Dust masks when required: Sweeping, dusting, raking
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Body protection: when working with acids, chemicals, battery charging, etc.
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Fall protection: when falls of 6' or greater, aerial lifts
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Knee pads: when necessary
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Other required PPE
Body Mechanics and Ergonomics
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Lifting/Carrying/Pulling/Pushing: Body movement
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Trash removal: from baskets, barrels, drums, carts
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Disposal of waste: to compactor and/or dumpster
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Restroom cleaning: toilets, mirrors, ect.
Tools and equipment
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Selection: Proper tool or equipment for job
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Condition: Tools and equipment in safe conditions for use
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Use: Tool and equipment being used as intented
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Mobile equipment: Inspected prior to use, safe ops.
Hazard communication/ chemicals
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Hazard Communication Written Program
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Chemical inventory list, Material Safety Data Sheet (MSDS)
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Proper labeling of containers
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Compatibility storage - acid/base
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Flammable storage cabinets
Regional Safety Initiatives for 2017
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Has the site completed their Safety Focus Plan (SFP)
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Has the site completed those items in the SFP?
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Has the site completed the required Self-inspection checklists for the month/Quarter?
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If there were deficiencies did the site create a CAP and correct those deficiencies?
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Has the site initiated the STARR Program?
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Has the site completed the minimum required STARRs for each month?
Follow-up
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Is any follow up required?<br><br>
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Commendable behaviors observed:
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