Information

  • Area

  • Conducted on

  • Prepared by

Safety

  • 1. Are emergency exits & fire extinguishers/hoses tagged for current inspection & clear of obstruction?

  • Photos

  • Corrective Actions

  • Assigned To

  • 5 =            All emergency exits and fire extinguishers/hoses tagged and identified for current inspection, clear of obstruction, and stored in prominent position.
    3 =            Some emergency exits and fire extinguishers/hoses tagged for current inspection and clear of obstruction.
    1 =            Emergency exits and fire extinguishers/hoses not tagged for current inspection and have obvious obstructions.

  • Score

  • 2. No apparent trip hazards on floors or stairwells.

  • Photos

  • Corrective Actions

  • Assigned To

  • 5 =            Floors and stairwells are clear of trip hazards
    3 = Trip hazards are apparent in some areas
    1 =            Trip hazards apparent in many areas

  • Score

  • 3. Hazardous materials, all containers, process tanks, & squeeze/spray bottles properly stored & labeled to contents.

  • Photos

  • Corrective Actions

  • Assigned To

  • 5 =            All hazardous materials, all containers, process tanks, and squeeze/spray bottles properly stored and labeled to contents.
    3 =            Some hazardous materials, all containers, process tanks, and squeeze/spray bottles properly stored and labeled to contents.
    1 =            All hazardous materials, all containers, process tanks, and squeeze/spray bottles are not properly stored and labeled to contents.

  • Score

  • 4. Machine guards, guardrails & safety switches properly in place & functioning.

  • Photos

  • Corrective Actions

  • Assigned To

  • 5 =            All machine guards, guardrails and safety switches properly in place and functioning.
    3 =            Some machine guards, guardrails and safety switches properly in place and functioning.
    1 =            Machine guards, guardrails and safety switches are not properly in place and functioning.

  • Score

  • 5. Field electrical panels, switches and MCC’s labeled & clear of obstruction.

  • Photos

  • Corrective Actions

  • Assigned To

  • 5 =            All field electrical panels, switches and MCC’s are labeled, and clear of obstruction.
    3 =            Some local electrical panels, switches and MCC’s are not labeled and clear of obstruction.
    1 =            All field electrical panels, switches and MCC’s are not labeled and have obvious obstructions.

  • Score

  • 6. Personal protective equipment being used and functioning?

  • Photos

  • Corrective Actions

  • Assigned To

  • 5 = PPE needs properly assessed and all individuals wearing designated PPE.
    3 = PPE needs properly assessed but some individuals not wearing designated PPE.
    1 = PPE needs not properly assessed and not in use.

  • Score

  • 7. Mobile equipment operating safely, in good condition and pre-shift inspections complete.

  • Photos

  • Corrective Actions

  • Assigned To

  • 5 = All safety related equipment properly functioning and pre-shift complete.
    3 = All safety related equipment properly function but pre-shift not complete.
    1 = Safety related equipment not functioning and pre-shift not complete.

  • Score

Sort

  • 8. Necessary materials & tools at work station or on benches.

  • Photos

  • Corrective Actions

  • Assigned To

  • 5 =            Work stations and benches are neat, clean, and organized with only necessary materials and tools present.
    3 =            Work stations and benches are mostly neat and clean with few unnecessary materials and tools
    1 =            Work stations and benches are not neat or clean with many unnecessary materials and tools

  • Score

  • 9. Materials, tools, & supplies in designated storage/staging areas.

  • Photos

  • Corrective Actions

  • Assigned To

  • 5 =            A designated area for materials, tools, and supplies which are labeled and neatly organized.
    3 =            A general area for materials, tools, and supplies with few labels and little organization.
    1 =            No designated area for materials, tools, and supplies with no labels or organization.

  • Score

  • 10. Area corners & below stairwells clear of clutter.

  • Photos

  • Corrective Actions

  • Assigned To

  • 5 =            All area corners and below stairwells are clean with no clutter.
    3 =            Area corners and below stairwells are generally clean with some clutter.
    1 =            All area corners and below stairwells are dirty with obvious clutter.

  • Score

  • 11. Documents & work instructions are available, updated and properly controlled.

  • Photos

  • Corrective Actions

  • Assigned To

  • 5 = Work documents clean, available, updated and properly controlled.
    3 = Work documents clean and available but not current.
    1 = Work instructions not available.

  • Score

Straighten

  • 12. Materials & tools organized, properly stored, identified, & point of use.

  • Photos

  • Corrective Actions

  • Assigned To

  • 5 =            Materials and tools are completely organized, clean, identified, and point of use.
    3 =            Materials and tools have a general area designated, most are organized, clean, and identified.
    1 =            Materials and tools don’t have a designated area, few are in proper location, and few are organized, clean, and identified.

  • Score

  • 13. Storage & staging areas clearly identified.

  • Photos

  • Corrective Actions

  • Assigned To

  • 5 =            All storage and staging areas are properly used and identified.
    3 =            Storage and staging areas have inconsistent use and identification.
    1 =            Storage and staging areas not properly used and identified.

  • Score

  • 14. Equipment free of unneeded materials & tools identified.

  • Photos

  • Corrective Actions

  • Assigned To

  • 5 = Equipment is clean, controls are labeled, no clutter,
    3 = Some controls are labeled, and some clutter on or around equipment.
    1 = Controls are not labeled, and apparent clutter around and on equipment.

  • Score

Shine

  • 15. Floors are swept, DRY & free of clutter.

  • Photos

  • Corrective Actions

  • Assigned To

  • 5 = All floor surfaces are clean with no debris.
    3 = All floor surfaces are generally clean with some debris.
    1 = All floor surfaces are dirty with obvious debris and wetness.

  • Score

  • 16. Aisleways are free of materials, garbage removed

  • Photos

  • Corrective Actions

  • Assigned To

  • 5 = All aisleways are clear of materials; garbage cans emptied.
    3 = Aisleways have some materials; garbage cans full
    1 = Aisleways have obvious clutter of materials; garbage cans overflowing.

  • Score

  • 17. Equipment cleaned & painted.

  • Photos

  • Corrective Actions

  • Assigned To

  • 5 = Paint is bright and equipment is clean
    3 = Paint is in good condition, equipment has some dirt
    1 = Paint is poor with chips and scrapes, equipment has obvious dirt

  • Score

  • 18. Work stations & benches wiped down.

  • Photos

  • Corrective Actions

  • Assigned To

  • 5 =            All shelves, benches, and stations are clean, organized and labeled
    3 =            Most shelves, benches, and stations have some dirt and are mostly organized
    1 =            Shelves, benches, and stations are cluttered with obvious dirt

  • Score

  • 19. Bulletin and Safety boards organized, have relevant & current information.

  • Photos

  • Corrective Actions

  • Assigned To

  • 5 = Bulletin boards organized with relevant and current information
    3 = Bulletin boards organized, but have outdated information
    1 = Bulletin boards disorganized and have outdated information

  • Score

  • 20. Area owner conducts & posts safety and housekeeping audits.

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  • Corrective Actions

  • Assigned To

  • 5 = Area owner conducts self audits and posts all audit results.
    3 = Area owner conducts self audits, but does not post all audit results.
    1 = Area owner does not conduct self audit and does not post any audit results.

  • Score

Standardize & Sustain

  • 21. Identification of recurring problem areas.

  • Photos

  • Corrective Actions

  • Assigned To

  • 5 =            Action item is highlighted on posted audit form and responsibilities assigned.
    3 =            Reoccurrence has been noted, little action taken to correct problem.
    1 =            No apparent action taken or planned to resolve problem area.

  • Score

  • 22. Employees and management committed to maintaining and sustaining housekeeping program.

  • Photos

  • Corrective Actions

  • Assigned To

  • 5 =            Complete commitment toward maintaining high scoring levels.
    3 =            Achieve average score but lack positive trends.
    1 =            Low scoring and show no trend toward improvements.

  • Score

  • General Audit Comments:

  • Signature

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