CHECKIT Worksite Inspection

• Site

• Inspector

• Location
  Address

• Date and Time

  Date

• Prepared by

• 
  INSTRUCTIONS:
  -------------------------------------
  
  1. Answer "SAFE", "UNSAFE", "N/A" for the questions below.
  2. Fill out required fields and answer other questions as needed.
  3. Add photos and notes/comments by clicking on the paperclip icon.
  4. To add a Corrective Measure, click on the paperclip icon then click on "Add Action". Provide a description, assign to a member, set priority and then set the due date.
  5. Complete audit by providing a digital signature.
  6. Share your report by exporting as PDF, Word, Excel or Web Link.
  
  

MECHANIC

• OSHA/State Compliance Posters

  SAFE

  UNSAFE

  N/A

• C&W Services Health & Safety/ Environmental Policies

  SAFE

  UNSAFE

  N/A

• Emergency Evacuation Plan

  SAFE

  UNSAFE

  N/A

• LOTO Program and Locks

  SAFE

  UNSAFE

  N/A

• Hazard Communication

  SAFE

  UNSAFE

  N/A

• -SDS Book –Location?

  SAFE

  UNSAFE

  N/A

• -Chemicals Properly Stored

  SAFE

  UNSAFE

  N/A

• -Chemical Bottles Properly Labeled

  SAFE

  UNSAFE

  N/A

• Storage Area Condition

  SAFE

  UNSAFE

  N/A

• -Walking Surfaces Clean, Dry & Free Of Trip Hazards<br>

  SAFE

  UNSAFE

  N/A

• -All Products Properly Stored (On Shelves Or Stacks <5’)

  SAFE

  UNSAFE

  N/A

• -Proper Lighting

  SAFE

  UNSAFE

  N/A

• -Eye Wash Facilities

  SAFE

  UNSAFE

  N/A

• Equipment Condition

  SAFE

  UNSAFE

  N/A

• -Portable circular saws equipped with guards

  SAFE

  UNSAFE

  N/A

• -Tool Handles & Grips

  SAFE

  UNSAFE

  N/A

• -Power & Extension Cords

  SAFE

  UNSAFE

  N/A

• -Are Grinders, with less of 1/8 on the work rest and ¼ on the top from the wheel

  SAFE

  UNSAFE

  N/A

• -Ladders (Step, Extension & Fiixed)

  SAFE

  UNSAFE

  N/A

• -Material Handling (Barrels, Dollies, Strap/Tie Down, Pallet Jack, Totes)

  SAFE

  UNSAFE

  N/A

• Personal Protective Equipment

  SAFE

  UNSAFE

  N/A

• -Eye/Face Protection (Glasses/Goggles/Face Shield)

  SAFE

  UNSAFE

  N/A

• -Hand/Skin Protection (Gloves/Clothing/Coveralls)

  SAFE

  UNSAFE

  N/A

• -Body Protection (fire rated)

  SAFE

  UNSAFE

  N/A

• -Foot Protection (Stabilicers/Toe Guards/Specialty Footwear)

  SAFE

  UNSAFE

  N/A

• -Specialty PPE (Site Specific)

  SAFE

  UNSAFE

  N/A

• Miscellaneous

  SAFE

  UNSAFE

  N/A

• Take5 in Place?

  SAFE

  UNSAFE

  N/A

• Ladder Inspections in Place

  SAFE

  UNSAFE

  N/A

• JSA’s in Place

  SAFE

  UNSAFE

  N/A

COMPLETION

• Inspector's Name and Signature

  Sign