CBIZ BP Loss Control - Follow Up Workplace Safety Assessment

• Audit Title

• Client / Site

• Document No.

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

General Safety and Health

• 1.0 - Have current Injury and Illness Prevention Program (IIPP)?

  Yes

  No

  N/A

• 1.1 - All new employees complete IIPP training and documentation has been verified?

  Yes

  No

  N/A

• 1.2 - Have current Hazard Communication program that includes current GHS changes?

  Yes

  No

  N/A

• 1.3 - All new employees complete HAZCOM/GHS training and documentation has been verified?

  Yes

  No

  N/A

• 1.4 - Have monthly safety meetings that all employees must attend?

  Yes

  No

  N/A

• 1.5 - Monthly safety meeting documentation verified?

  Yes

  No

  N/A

• 1.6 - Have current Personal Protection Equipment (PPE) hazard assessment?

  Yes

  No

  N/A

• Select all required and optional PPE

  Select eye protection face protection dust mask respirator foot protection gloves hard hat cut protection fall protection hearing protection back brace reflective vest slip resistance shoes

  • eye protection
  • face protection
  • dust mask
  • respirator
  • foot protection
  • gloves
  • hard hat
  • cut protection
  • fall protection
  • hearing protection
  • back brace
  • reflective vest
  • slip resistance shoes

• All required PPE use observed?

  Yes

  No

  N/A

• 1.7 - Have hearing conservation program?

  Yes

  No

  N/A

• 1.8 - Do all affected employees receive hearing conservation training and testing, and documentation has been verified?

  Yes

  No

  N/A

• 1.9 - All employees complete PPE training that is specific to the task they will perform on the job and documentation has been verified?

  Yes

  No

  N/A

• 1.10 - Have current Fall Protection Program?

  Yes

  No

  N/A

• 1.11- All affected employees complete Fall Protection training and documentation has been verified?

  Yes

  No

  N/A

• 1.12 - Have Emergency Evacuation Program and maps are posted?

  Yes

  No

  N/A

• 1.13 - Emergency Evacuation training is completed by all employees and documentation has been verified?

  Yes

  No

  N/A

• 1.14 - Have Lock Out Tag Out (LOTO)Program?

  Yes

  No

  N/A

• 1.15 - All employees complete basic LOTO training and documentation has been verified?

  Yes

  No

  N/A

• 1.16 - Specific employees that perform maintenance, service or equipment repairs complete comprehensive LOTO training and documentation has been verified?

  Yes

  No

  N/A

• 1.17 - Have accident/incident reporting procedures and training is conducted with all employees?

  Yes

  No

  N/A

• 1.18 - Is Material Handling Equipment (MHE) in use?

  Yes

  No

  N/A

• Types of Material Handling Equipment (MHE)?

  Select Class 1 - Electrical Motor Rider Trucks (i.e Sit Down/Stand Up Rider) Class 2 - Electrical Motor Narrow Aisle Trucks (I.e. high lift straddle, order picker, reach type outrigger, side loaders, turret trucks, swings mast and convertible turret/stock pickers, low lift pallet and platform rider) Class 3 - Electrical Motor Hand or Hand/Rider Trucks (I.e. low lift platform, low lift walkie pallet, reach type outrigger, high lift straddle, high lift counterbalanced, low lift walkie/ricer pallet Class 4 - Internal Combustion Engine Trucks (Sit Down, Gas or LPG Class 5 - Internal Combustion Engine Trucks (I.e. sit down rider fork, gas or LPG, Fork, Counterbalanced) Class 7 - Electrical and Internal Combustion Engine Tractor (Straight Mast forklift, Extended Reach Forklift) Gantry/Overhead

  • Class 1 - Electrical Motor Rider Trucks (i.e Sit Down/Stand Up Rider)
  • Class 2 - Electrical Motor Narrow Aisle Trucks (I.e. high lift straddle, order picker, reach type outrigger, side loaders, turret trucks, swings mast and convertible turret/stock pickers, low lift pallet and platform rider)
  • Class 3 - Electrical Motor Hand or Hand/Rider Trucks (I.e. low lift platform, low lift walkie pallet, reach type outrigger, high lift straddle, high lift counterbalanced, low lift walkie/ricer pallet
  • Class 4 - Internal Combustion Engine Trucks (Sit Down, Gas or LPG
  • Class 5 - Internal Combustion Engine Trucks (I.e. sit down rider fork, gas or LPG, Fork, Counterbalanced)
  • Class 7 - Electrical and Internal Combustion Engine Tractor (Straight Mast forklift, Extended Reach Forklift)
  • Gantry/Overhead

• 1.18 (a) - Are Load Weight Capacity Tags Legible?

  Yes

  No

  N/A

• 1.18 (b) - Have Material Handling Equipment (MHE) training and safety program?

  Yes

  No

  N/A

• 1.18 (c) - Are MHE operators trained specifically for the equipment they will be operating and training documentation has been verified?

  Yes

  No

  N/A

• 1.19 - Is Heat Illness Awareness/Prevention Program Required?<br>

  YES

  NO

• 1.19 (a) - Has Training been conducted and Documentation Verified?

  Yes

  No

  N/A

2.0 - Fire Prevention

• 2.1 - Evacuation plan displayed and understood by all employees?

  Yes

  No

  N/A

• 2.2 - Evacuation procedures discussed regularly? (3 to 4 times a year)

  Yes

  No

  N/A

• 2.3 - Extinguishers in place, clearly marked for type of fire?

  Yes

  No

  N/A

• 2.4 - Extinguishers serviced/documented annually?

  Yes

  No

  N/A

• 2.5 Extinguishers inspected/documented monthly?<br>

  Yes

  No

  N/A

• 2.6 - Extinguishers clear of obstructions?

  Yes

  No

  N/A

• 2.7 - Adequate direction notices for fire exits?

  Yes

  No

  N/A

• 2.8 - Exit doors easily opened from inside?

  Yes

  No

  N/A

• 2.9 - Exits clear of obstructions?

  Yes

  No

  N/A

3.0 - General Lighting

• 3.1 - Good natural lighting?

  Yes

  No

  N/A

• 3.2 - Reflected light from walls & ceilings not causing glare to employees?

  Yes

  No

  N/A

• 3.3 - Light fittings clean and in good condition?

  Yes

  No

  N/A

• 3.4 - Emergency exit lighting operable?

  Yes

  No

  N/A

4.0 - Building Safety

• 4.1 - Uneven Floor Surfaces Identified and Marked?

  Yes

  No

  N/A

• 4.2 - Entry and walkways kept clear?

  Yes

  No

  N/A

• 4.3 - Walkways adequately and clearly marked?

  Yes

  No

  N/A

• 4.4 - Intersections kept clear of boxes etc?

  Yes

  No

  N/A

• 4.5 - Stair and risers kept clear?

  Yes

  No

  N/A

• 4.6 - Are liquid spills removed quickly?

  Yes

  No

  N/A

• 4.7 - Are railings in good condition?

  Yes

  No

  N/A

• 4.8 - Are fall preventive measures in place and used where gaps occur in railings?

  Yes

  No

  N/A

• 4.9 - Are footpaths in good condition?

  Yes

  No

  N/A

• 4.10 - Loading area clean and tidy?

  Yes

  No

  N/A

5.0 - Work Benches

• 5.1 - Clear of debris?

  Yes

  No

  N/A

• 5.2 - Tools not in use kept in place?

  Yes

  No

  N/A

• 5.3 - Damaged hand tools taken out of service?

  Yes

  No

  N/A

• 5.4 - Damaged power tools taken out of service?

  Yes

  No

  N/A

• 5.5 - Work height correct for the type of work and the employee?

  Yes

  No

  N/A

• 5.6 - Sharp edges protected or eliminated?

  Yes

  No

  N/A

6.0 - Trash Removal

• 6.1 - Bins located at suitable points around site?

  Yes

  No

  N/A

• 6.2 - Bins emptied regularly?

  Yes

  No

  N/A

• 6.3 - Oily rags and combustible refuse in covered metal containers?

  Yes

  No

  N/A

7.0 - Storage Design and Use

• 7.1 - Materials stored in racks and bins wherever possible?

  Yes

  No

  N/A

• 7.2 - Racks load bearing weight rated and visible?

  Yes

  No

  N/A

• 7.3 - Floors around racking clear of debris?

  Yes

  No

  N/A

• 7.4 - General condition of racks and pallets?

  Yes

  No

  N/A

8.0 - Machines

• 8.1 - Are they kept clean?

  Yes

  No

  N/A

• 8.2 - Are the floors around the machines kept clean?

  Yes

  No

  N/A

• 8.3 - Guards in place and in good condition?

  Yes

  No

  N/A

• 8.4 - Machinery equipped with emergency shut-off and within reach of operator?

  Yes

  No

  N/A

• 8.5 - Waste/off cuts removed and stored safely?

  Yes

  No

  N/A

• 8.6 - Drip pans on floor to prevent spillage?

  Yes

  No

  N/A

• 8.7 - Adequate work space?

  Yes

  No

  N/A

• 8.8 - Is lighting adequate?

  Yes

  No

  N/A

• 8.9 - Noise levels controlled?

  Yes

  No

  N/A

• 8.10 - No bending or stooping required?

  YES

  NO

• 8.11 - Operators trained on the specific operation of the machines?

  Yes

  No

  N/A

• 8.12 - Is the training recorded?

  Yes

  No

  N/A

• 8.13 - Do operators comply with the training?

  Yes

  No

  N/A

9.0 - Electrical Safety

• 9.1 - Safety switches installed?

  Yes

  No

  N/A

• 9.2 - Safety switches tested every 6 months and tests documented?

  Yes

  No

  N/A

• 9.3 - Are double adapters present (Daisy chain, Piggy backing, etc.)

  YES

  NO

• 9.4 - Portable equipment tested and tagged?

  Yes

  No

  N/A

• 9.5 - No broken plugs, sockets or switches?

  YES

  NO

• 9.6 - No flexible cords across walkways?

  YES

  NO

• 9.7 - No frayed or damaged flexible cords?

  YES

  NO

• 9.8 - No strained cords?

  YES

  NO

• 9.9 -Temporary flexible power cords used for intended purpose and in good condition?

  Yes

  No

  N/A

• 9.10 - Are all electrical cabinets, junction, switch boxes properly covered and protected?

  Yes

  No

  N/A

10.0 - Chemical Safety

• 10.1 - Hazardous Substance Inventory complete and available?

  Yes

  No

  N/A

• 10.2 - Safety Data Sheets (SDS) available for all chemicals?

  Yes

  No

  N/A

• 10.3 - All containers labelled correctly?

  Yes

  No

  N/A

• 10.4 - Unused substances disposed of?

  Yes

  No

  N/A

• 10.5 - Do special storage conditions apply?

  YES

  NO

• 10.5 (a) - Are special storage conditions followed?

  Yes

  No

  N/A

• 10.6 - Workers trained in the use of hazardous substances?

  Yes

  No

  N/A

• 10.7 - If required is PPE available?

  Yes

  No

  N/A

• 10.8 - Is adequate ventilation provided?

  Yes

  No

  N/A

• 10.9 - Are eye washes and showers easily accessed?

  Yes

  No

  N/A

• 10.10 - Are Eye Was Stations and/or Showers Inspected Tagged & Serviced Accordingly

  Yes

  No

  N/A

11.0 Ladders

• 11.1 - Ladder Use or Ladders Present?

  YES

  NO

• 11.2 - Have Ladder Safety Program and Documented?

  Yes

  No

  N/A

• 11.3 - Are all ladders Industrial strength? (Non Household rated, check label.)

  Yes

  No

  N/A

• 11.4 - Are ladders in good condition?

  Yes

  No

  N/A

• 11.5 - If used for electrical work are they non conductive? (Wood or fibre glass.)

  Yes

  No

  N/A

• 11.6 - Used according to instructions?

  Yes

  No

  N/A

• 11.7 - For extension ladders are ropes, pulleys and treads in a good state of repair?

  Yes

  No

  N/A

• 11.8 - Is comprehensive safe ladder use training documented with all employees required to use ladders?

  Yes

  No

  N/A

• 11.9 - Employees that have not completed ladder training are restricted from ladder use?

  Yes

  No

  N/A

12.0 - First Aid Facilities

• 12.1 - Are cabinets and contents clean and orderly?

  Yes

  No

  N/A

• 12.2 - Are contents regularly checked?

  Yes

  No

  N/A

• 12.3 - Contents past their expiration date discarded?

  Yes

  No

  N/A

• 12.4 - Cabinets clearly labelled?

  Yes

  No

  N/A

• 12.5 - Is there easy access to cabinets?

  Yes

  No

  N/A

• 12.6 - Employees aware of location of first aid cabinet?

  Yes

  No

  N/A

• 12.7 - Are emergency numbers displayed?

  Yes

  No

  N/A

• 12.8 - Is injury reporting contact personnel available?

  Yes

  No

  N/A

13.0 Height Exposures

• Height Exposure Category

  4 Feet or Less

  4 to 15 Feet

  15 to 25 Feet

  25 Feet or Above

• 13.1 Is there scaffolding?

  YES

  NO

• 13.2 Scaffolding training for affected employees training conducted & documentation verified?

  Yes

  No

  N/A

• 13.3 Is a designated competent person onsite?

  Yes

  No

  N/A

• 13.4 Are Scissor lifts used by Employees?

  Yes

  No

  N/A

• 13.4 (a) Has the operator been trained and documentation verified?

  Yes

  No

  N/A

• 13.5 Are Articulating Booms used by Employees?

  Yes

  No

  N/A

• 13.5 (a) Has the operator been trained and documentation verified?

  YES

  NO

• 13.5 (b) Have affected employees been trained on the proper use of personal fall arrest systems

  Yes

  No

  N/A

• 13.6 Any Catwalk Exposures ?

  YES

  NO

• 13.6 (a) Are required fall prevention measures in place?

  Yes

  No

  N/A

14.0 Additional Hazards/Concerns or Safe Behaviors

Hazard/Concern or Safe Behavior

• Hazard/Concern or Safe Behavior:

  Safe

  At Risk

  N/A

• Photo(s) of Hazard/Concern or Safe Behavior:

  Media

• Drawing of Hazard/Concern or Safe Behavior, if applicable:

  Drawing

Sign Off

• Marsh & McLennan Loss Control Representative's Signature:

  Sign