Title Page
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Client/Site
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Date
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Prepared by
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Location
Bench Grinder
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Bench grinder tongue guard < 1/4", rest < 1/8"
Bloodborne Pathogens
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Bloodborne pathogens response equipment available
Compressed Gas
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Caps on cylinders when not in use
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Compressed gas cylinder storage labeled
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Cylinders secure, chained top 1/3
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Full and empty cylinders stored separately
Cranes and Slings
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Crane controls legible
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Cranes hoists labeled with capacity
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Crane rails labeled with capacity
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Daily crane inspections conducted and documented
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Out of service craned marked "Out of Service"
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Slings in good condition. Damaged slings discarded
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Slings inspected quarterly and documented
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Slings properly documented, not in pile
Electrical
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Electrical boxes labeled with voltage and purpose
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Electrical boxes' doors closed
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Electrical equipment has 36" clearance
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Extension cords are adequate for load (no spiraling of cover)
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Extension cords free of cuts, splices, deformation, tape
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Extension cords not used for permanent power supply
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No "daisy-chaining" of power strips
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Out of service equipment labeled "Out of Service"
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Power strips are industrial grade
Emergency Action
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Emergency phone numbers posted
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Evacuation map posted
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Emergency lighting available to exit building
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Emergency shelter signs posted
Exits
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Exits marked and unobstructed
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Exits that are not exits labeled "Not An Ext"
Eye Wash and Safety Shower
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Eye wash tested
Fall Protection
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Fall protection harnesses inspected quarterly and documented
Fire Extinguisher
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Fire extinguisher charged (gauge in green)
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Fire extinguisher hydrotest current (<5 yrs)
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Fire extinguishers in good condition, free of corrosion
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Fire extinguishers inspected monthly and documented
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Fire extinguishers mounted
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Fire extinguishers sign present
Fire Suppression System
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Paint booth air filters within normal operating limits
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Paint booth sprinkler heads free of excessive buildup
First Aid and CPR
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At least one person certified in first aid and CPR present each shift
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First aid kit available and adequately supplied
Flammable Materials
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Flammable cabinet doors closed
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Flammable cabinet grounded
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Flammable cabinets free of objects on top of cabinet
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Flammable materials stored in NFPA approved containers
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Previously opened flammable materials stored in flammable cabinet
Forklift
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Daily inspections conducted and documented
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Forklift operators wearing seat belts
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Horn sounded when turning corner
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Operator license available
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System available to confirm all daily inspections performed
Hand & Port Power Tools
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No homemade tools
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Portable grinders abrasive wheel > 2" guarded
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Portable power tools in good condition
Hazardous Waste
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Hazardous waste drums labeled with accumulation start date
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Hazardous waste storage aisle space adequate to inspect containers
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Hazardous waste storage area clean and free of debris
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No paint cans present outside of waste drums
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Spill kit available
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Waste drums are closed
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Weekly hazardous waste inspections are current
HazCom
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Labels on secondary containers
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Safety Data Sheets Available
Hearing Conservation
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Areas requiring hearing protection labeled
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Personnel wearing hearing protection where required
Heat Stress
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Heat stress signage posted in restrooms
Housekeeping
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Area free of debris and liter
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No food present in workplace
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Restroom facilities clean. Hot and cold water. Towels available.
Job Safety Analysis
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Job Safety Assessments (JSAs) available in work area.
Ladders
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Ladders inspected and documented quarterly
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Ladders inspected before use
Lockout/Tagout
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LOTO procedures present
Machine Guarding
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Machine guards present
Material Storage
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Load limit on racking
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Racking anchored to floor
OSHA 300 Log
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OSHA 300 log posted 2/1 - 4/30
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OSHA 300A submitted electronically by 4/30/XX
Outside Storage
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No evidence of staining, release or debris from outside storage
Petroleum Handling
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No evidence of spill, release or staining
Posters
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Federal and state labor posters posted
PPE
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Personnel wearing safety glasses
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Personnel wearing steel toed shoes
Respiratory Protection
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Respirators clean and in good condition
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Respirators properly stored (individual bag with name)
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Respirators used in required areas
Sanitation/Housekeeping
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Restroom facilities clean, hot and cold water, towels available
Stormwater
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No evidence of staining, release or debris from outside storage
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No evidence release affecting stormwater
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Stormwater outfall labeled
Universal Waste
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Aerosol cans accumulated in container marked "Aerosol Cans"
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Aerosol cans punctured in commercially available unit
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Aerosol cans punctured placed in scrap metal container
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Battery containers closed
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Battery containers have start date < 1 Yr
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Battery containers labeled "Universal Waste"
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Contents of aerosol cans recycled
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Fluorescent lamp containers closed
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Fluorescent lamp containers have start date < 1 Yr
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Fluorescent lamp containers labeled "Universal Waste"
Used Oil
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Used oil accumulation are clean, neat, orderly
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Used oil containers closed, bungs in place
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Used oil containers in good condition, no dents, no oil on top or sides
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Used oil containers labeled, "Used Oil" not "Waste Oil"
Walk-Work Surfaces
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Area free of trip hazards
Waste Management
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No unknown material present
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Out of date materials properly disposed
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Used materials properly stored
Welding
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No visible fugitive emissions of welding fumes from building
Completion
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Additional Notes
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Sign Off
