• Document No.

  • Shift

  • Conducted on

  • Prepared by

  • Area


  • 1. Are personnel using the required PPE, and are they using it properly?<br><br>

  • 2. Is shared PPE stored properly and are sanitation wipes available for cleaning?<br><br>

  • 3. Are signs in place at entrance ways identifying what PPE is required in the area?<br><br>

Machine Safety & Guarding

  • 1. Are machine guards attached and secured? Are rotating and moving parts of equipment guarded to prevent physical contact? (Equipment under 7 ft of ground or platform must be guarded)<br><br>

  • 2. Are machines that are designed for a fixed location securely anchored to prevent walking or moving?<br><br>

  • 3. Do the employees in the area know where the emergency E-stops are for the machines?<br>

  • 4. Are air hoses and hose connections designed for the pressure and service to which they are subjected?<br>

Building Safety

  • 1. Is an inspection of emergency eyewash/shower performed monthly and documented? Are eyewash basins maintained in sanitary condition and easily accessible for emergency situations (clearance of 36 inches)?<br>

  • 2. Are all exits signs illuminated and identified? Are all emergency lights working?<br><br>

  • 3. Are evacuation routes properly posted and free of congestion or obstruction?<br><br>

  • 4 . Are doors, passageways orstairways that are neither exits or access to exits, and which could be mistaken for exits appropriately marked "NOT AN EXIT", "TO BASEMENT", etc? Are exit doors able to be opened from the direction of exit travel without hte use of a key or any special knowledge or effort when teh building is occupied?

  • 5. Are all work areas adequately illuminated?<br>

  • 6. Is the emergency phone number posted on all telephones in the area?<br>

  • 7. Are domed mirrors in good condition with no holes, cracks and properly anchored (Not to a pipe or conduit)

Walking and Working Surfaces

  • 1. Are there any slip, trip and fall hazards in or around the walking-working surfaces in the area? ( no holes, uneven floors or working surfaces, torn carpet or tile, debris or slick spots, wet areas, grates intact and secure)? <br><br><br>

  • 2. Is glass in windows and doors in good condition, with no cracks, and are not dirty or covered to impede vision before entering or exiting the area, or cause injury if handled?

  • 3. Are all flights of stairs having four or more risers equipped with standard stair railings or standard handrails? Are step risers on stairs uniform from top to bottom?

  • 4. Are guardrails installed on elevated working platforms, mezzanines, scissor lifts, etc?<br>

  • 5. Do fixed ladders to platforms have a self closing gate or 2 chains at the top?<br>

  • 6. Are changes in elevations on walkways readily identifiable?<br><br>

  • 7. Are all portable ladders maintained in good condition, joints between steps and side rails tight, all hardware and fittings securely attached (no missing bolts, free of cracks)? Are rungs free of grease and oil? Non-slip feet on bottom?<br>

Fire Protection

  • <br>1. Are fire doors unobstructed and protected against obstructions (includes roll-down and side-hinged doors)? Are fire doors on stairways self-closing and not obstructed or propped open?<br><br>

  • 2. Is proper clearance (at least 18”) maintained below sprinkler heads?<br><br>

  • 3. Are "NO SMOKING" signs posted where appropriate in areas where flammable or combustible materials are used or stored (25 feet)?<br><br>

  • 4. Are fire extinguisher locations identified so that employees can see them?<br>Are all fire extinguishers and fire hoses in good condition and accessible (must have 3 feet of clearance)? Are Extinguishers properly mounted (cannot be free-standing on floor), charged and checked monthly?<br>

Moving and Lifting

  • 1. Are forklifts, walkie riders, pallet jacks and scissor/one man lift inspection records completed for those units in use? (once per shift) Are records available and current?<br><br>

  • 3. Are trucks and trailers secured from movement during loading and unloading operations by wheel chocks? Are dock locks being used and used correctly?<br>

  • 4. When trailers are unhooked from tractors, are they secured from falling when driving in and out by the use of jack stands?<br><br>

  • 5. Are the controls of hoist plainly marked to indicate the direction of travel or motion? Is load rating clearly marked and visible?<br>

Electrical Safe Work Practices

  • 1. Are all unused openings (including conduit knock-outs in junction boxes) in electrical enclosures and fittings closed with appropriate covers, plugs or plates?<br><br>

  • 2. Are doors to electric panels (including those to MCC rooms) secured shut when not being serviced?<br><br>

  • 3. Are cords and cables free of splices, tape, frays or deterioration and plugs in good shape (3 prongs on extension cords_? Are extension cords used only on a temporary basis? (Cannot be used more than 90 days, and cannot be attached or wrapped around anything or passed under metal doorways.) <br><br><br>

  • 4. Are arc flash labels on machines and/or equipment in the area?<br><br>

  • 5. Is proper clearance (36 inches) maintained in front of all electric panels and cabinets? Remove any items.<br>

  • 6. Are refrigerators, microwaves, and other appliances plugged directly into the wall (no extension cords or surge protectors? Are portable fans equipped with an on/off switch, and is it in working condition?<br><br>

  • 7. Are all disconnecting switches and circuit breakers labeled to indicate their use or equipment served?<br>

Hazard Communication

  • 1. Can the employees in the area access the online SDS library?

  • 2. Are pipelines identified at regular intervals, and is this information readily visible on the pipe near each valve or outlet?<br><br>

  • 3. Do all containers properly identify content with SDS number, primary hazard class and chemical name? This includes buckets, drums, pipes, and other containers.<br><br>

  • 4. Are all propane storage tanks stored outside the plant? Is signage appropriate?<br>

  • 5. Are flammable liquids kept in the proper container or cabinet?

Lockout Tagout

  • 1. Is information on tags connected to lockout locks in use completed properly and legible? is a properly completed tag connected to each lockout currently in use in the area?<br>

  • 2. Does everyone working on the machine have a lock and tag on the machine/lockbox?<br>

  • 3. Can employees pull up safety/ lockout instructions?


  • 1. Is there a Hot Work Permit posted in the area where the Hotwork is happening? Is there a fire extinguisher within 10 feet of the hotwork? Is there a person designated as Fire Watch?


  • 1. Are idle pallets stored flat (not propped on side or leaning)? Are pallets stacked 14 or less high and not taller than 6ft?

  • 2. Are tools used by people in the area in good condition? Are they being used properly?<br>

  • 3. Is the work area maintained in a clean and orderly condition?<br>

  • 6. Boxes and containers are being stored in a way that none are leaning or causing any safety issues?<br>

  • 7. Are air and water hoses out of pathways?<br>

Other Items

  • Add any additional Notes below


  • Auditor:

  • Supervisor:

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