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.

  • Photos

  • 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

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.