CMH #955 Department Safety Inspection

• Site

• Location
  Address

• Inspection By

• Date

  Date

• Instructions:
  ----------------
  1. Answer "Yes", "No", "N/A" for the questions.
  2. Add photos and notes by clicking on the paperclip icon, if applicable.
  3. To add a Corrective Actions click on the paperclip icon then "Add Action", provide a description, assign to a member, set priority and due date.
  4. Complete audit by providing digital signature.
  5. Share your report by exporting as PDF, Word, Excel or Web Link.
  
  Points Reference: A (90-100) B (80-89) C (70-79) F (<70)

A. Walking Surfaces

• Aisles are established and kept clear

  Yes

  No

  N/A

• No tripping hazards present

  Yes

  No

  N/A

• Minimal holes and cracks

  Yes

  No

  N/A

• Floors are kept dry as practical

  Yes

  No

  N/A

• Ladders in good operating condition

  Yes

  No

  N/A

B. Electrical Hazards

• Ext. cords not used as permanent source

  Yes

  No

  N/A

• All ext. cords are of 3-wire type

  Yes

  No

  N/A

• Ext. cords plugged directly into outlet

  Yes

  No

  N/A

• Ext. cords in good condition (no tape)

  Yes

  No

  N/A

• All outlet/junction box covers in place

  Yes

  No

  N/A

• Circuit panels are kept clear (min. 36 inches)

  Yes

  No

  N/A

• Wires/cords do not run in traffic areas

  Yes

  No

  N/A

• LOTO procedures followed

  Yes

  No

  N/A

C. Fire Prevention, Emergency Exits

• Fire extinguishers are not obstructed

  Yes

  No

  N/A

• Fire doors are not blocked

  Yes

  No

  N/A

• Exits are unobstructed & unlocked

  Yes

  No

  N/A

• Exits properly marked

  Yes

  No

  N/A

• Good housekeeping is practiced

  Yes

  No

  N/A

• Liquid spills are absorbed

  Yes

  No

  N/A

• Excess trash/paper is removed

  Yes

  No

  N/A

• Flammables stored correctly

  Yes

  No

  N/A

• Heaters used safely

  Yes

  No

  N/A

Fall Protection

• Harnesses are in good repair

  Yes

  No

  N/A

• Lanyards are in good repair

  Yes

  No

  N/A

• Daily inspection of fall protection equipment performed

  Yes

  No

  N/A

• Team members wearing fall protection equipment as required

  Yes

  No

  N/A

• LOTO procedures followed

  Yes

  No

  N/A

• Catwalks 12" or less from the floor and 6' or less from the roof edge

  Yes

  No

  N/A

• End wall scaffolds 12" or less from the floor and catwalks

  Yes

  No

  N/A

Saw Safety

• Guards in place and working properly

  Yes

  No

  N/A

• Team member keeps hands 6" away

  Yes

  No

  N/A

• Gloves and loose clothing removed while operating

  Yes

  No

  N/A

Nail Gun Safety

• Nail gun is sequential fire (where applicable)

  Yes

  No

  N/A

• Team member keeps hands 6" away

  Yes

  No

  N/A

• Tool is in good working condition

  Yes

  No

  N/A

Line Roll

• Floor cleared by line roll operator

  Yes

  No

  N/A

• Line roll chains in good repair

  Yes

  No

  N/A

• LOTO procedures followed

  Yes

  No

  N/A

• Spotter utilized during the line roll

  Yes

  No

  N/A

Hoist Safety

• Controls clearly marked

  Yes

  No

  N/A

• Safety latches in good condition

  Yes

  No

  N/A

• Rigging in good condition and load capacity marked

  Yes

  No

  N/A

• Loads not left suspended and unattended

  Yes

  No

  N/A

• No team member under a suspended load

  Yes

  No

  N/A

E. General

• Adherence to smoking policies

  Yes

  No

  N/A

• Personal Protective Equipment

  Yes

  No

  N/A

• Cut resistant gloves are worn as required

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Completion

• Inspected By: (Name & Signature)

  Sign