Commercial safety Audit Report

• Store#

• Location
  Address

• Conducted on

  Date

• Prepared by

• Store manager

Line Driven Safety

• Does the manager have an understanding of the Line Driven Safety?

  Yes

  No

  N/A

• Was the quarterly IIP review held<br>between the store manager and their<br>market manager?

  Yes

  No

  N/A

• Is safety performance part of the store<br>manager's performance evaluation?

  Yes

  No

  N/A

• Was the quarterly IIP survey completed?

  Yes

  No

  N/A

• Was the quarterly IIP survey completed<br>accurately?

  Yes

  No

  N/A

• Does the IIP completion and injuries (or<br>lack of injuries) seem to match?

  Yes

  No

  N/A

• Does the location have a safety<br>committee with IIP activities assigned to<br>its members?

  Yes

  No

  N/A

• Does the Store Manager know how to<br>access the Safety Net?

  Yes

  No

  N/A

• Does the Store Manager know where to<br>find written safety programs?

  Yes

  No

  N/A

• Are the weekly Site Safety Checklist,<br>Ways of Working Observations and 4S<br>Checklist being completed?

  Yes

  No

  N/A

Hot Work

• Does the site perform any hot work<br>(torching, welding, brazing, grinding,<br>etc.)

  Yes

  No

• Yes

  No

  N/A

• Yes

  No

  N/A

Compressed Gas Cylinders

• Does the location have any compressed gas cylinders?

  Yes

  No

• Yes

  No

  N/A

Fire Protection & suppression System

• Does the site have a fire suppression system (sprinklers)?

  Yes

  No

• Is the suppression system inspection<br>current?

  Yes

  No

  N/A

• Is the sprinkler system visibly in good<br>shape (excessive dust, blocked by<br>storage, etc.)?

  Yes

  No

  N/A

• Does the site have fire extinguishers<br>available?

  Yes

  No

  N/A

• Are extinguishers current on annual and<br>monthly inspections?

  Yes

  No

  N/A

• Have employees been properly trained<br>to use the extinguishers (annual<br>information per OSHA req.)?

  Yes

  No

  N/A

• Are extinguishers unblocked and have<br>free access?

  Yes

  No

  N/A

Respiratory Protections

• Would you like to review respiratory protection?

  Yes

  No

• Does the site use respirators (N95, tight<br>fitting, hoods, etc.)

  Yes

  No

  N/A

• Yes

  No

  N/A

Bloodborne Pathogens

• Would you like to review bloodborne pathogens?

  Yes

  No

• Does the site have employees that are<br>classified as "reasonably anticipated" to<br>have contact with BBP?

  No

  Yes

  N/A

• Have all teammates labeled as having a<br>"reasonable chance of exposure" been<br>offered the Hepatitis B Vaccination at no<br>cost?

  Yes

  No

  N/A

• Are records of the HBV maintained?

  Yes

  No

  N/A

• Has the site had any potential BBP<br>exposures?

  No

  Yes

  N/A

Hearing Conservations

• Would you like to review hearing conservation?

  Yes

  No

• Does the location have teammates in a<br>hearing conservation program?

  Yes

  No

  N/A

• Are all teammates below the action level<br>that requires a hearing conservation<br>program?

  Yes

  No

  N/A

Contractors

• Would you like to review Contractors?

  Yes

  No

• Has the site used any contractors?

  Yes

  No

  N/A

• Are contractors signing in as<br>contractors/visitors?

  Yes

  No

  N/A

• Is the site holding contractors to our<br>safety standards (safety glasses, safety<br>shoes, LOTO, etc.)?

  Yes

  No

  N/A

Power Industrial

• Would you like to review power industrial trucks (forklifts)?

  Yes

  No

• Have all operators of PITs been trained<br>within the past 2 years and after any PIT<br>related incidents?

  Yes

  No

  N/A

• Are daily PIT inspections being<br>documented?

  Yes

  No

  N/A

• Do the daily inspections appear to be<br>accurate and not pencil whipped or<br>photo copied?

  Yes

  No

  N/A

• Is the PIT in good working condition and<br>does the daily inspection match the<br>condition of the PIT?

  Yes

  No

  N/A

• Are PIT operators operating the<br>equipment in a safe manner?<br>(observation)

  Yes

  No

  N/A

Fundamental Safety Activities

• Would you like to review the<br>fundamental safety activities (FSA)?

  Yes

  No

• Have all required teammates had FSA<br>training?

  Yes

  No

  N/A

• Has the store completed their quarterly<br>KY activities?

  Yes

  No

  N/A

• Is the 4S checklist being completed<br>accurately?

  Yes

  No

  N/A

• Are 4S tasks assigned to teammates to<br>ensure completion on a regular/constant<br>basis?

  Yes

  No

  N/A

• Does the observed 4S of the location<br>match the record of completed 4S<br>checklists?

  Yes

  No

  N/A

PPE

• Would you like to review personal<br>protective equipment (PPE)?

  Yes

  No

• Has there been any PPE related<br>discipline?

  Yes

  No

  N/A

• Are teammates actively using the correct<br>PPE? (observation)

  Yes

  No

  N/A

• Is the PPE being worn appropriate to the<br>task being performed (grinding w/ face<br>shield, chemical resistant gloves when<br>handling chemicals, etc.)

  Yes

  No

  N/A

Emergencies

• Would you like to review emergency<br>plans?

  Yes

  No

• Does the location have a written<br>emergency plan?

  Yes

  No

  N/A

• Does the plan include emergencies<br>other than fire and weather (i.e. bomb<br>threat, active shooter, earthquake,<br>neighbors, etc.)?

  Yes

  No

  N/A

• Does the plan include provisions for<br>drills that include different types of<br>emergencies (weather, fire, bomb threat,<br>neighbors, etc.)

  Yes

  No

  N/A

• Are records of the drills being<br>maintained?

  Yes

  No

  N/A

• Do all emergency exits have clear<br>access paths? (includes path to the<br>door, the door itself and the path outside<br>exit doors)

  Yes

  No

  N/A

• Are evacuation route maps posted and<br>legible?

  Yes

  No

  N/A

• Are emergency exits clearly marked<br>(1910.37 - Lettering 6" tall, Lighted, no<br>flammables in path, etc.)?

  Yes

  No

  N/A

Hazard Communication / GHS / Right - to Know

• Would you like to review hazard<br>communications (GHS)?

  Yes

  No

• Does the location have a written Hazard<br>Communications program (GHS)?

  Yes

  No

  N/A

• Is there a process to train Teammates<br>on the requirements of GHS (labeling,<br>training & SDS)?

  Yes

  No

  N/A

• Is there a process to manage new<br>incoming chemicals and disposal of old<br>chemicals?

  Yes

  No

  N/A

• Is there a listing of hazardous<br>substances used on site?

  Yes

  No

  N/A

• Are SDS available for all substances on<br>site?

  Yes

  No

  N/A

• Do teammates understand how to<br>access SDS if needed?<br>(observation/discussion with teammates)

  Yes

  No

  N/A

Lockout / Tagout

• Would you like to review Lockout / Tagout?

  Yes

  No

• Yes

  No

  N/A

Heat Stress

• Would you like to review heat stress?

  Yes

  No

• Does the site have a heat stress<br>prevention program?

  Yes

  No

  N/A

• Are teammates properly trained on heat<br>stress and how to prevent it?

  Yes

  No

  N/A

Recordkeeping

• Would you like to review OSHA, MSHA<br>or DOT recordkeeping?

  Yes

  No

• Which regulations apply to this site's<br>workers?

  OSHA

  MSHA

  MSHA / OSHA

• Does the site have the current year plus<br>5 previous years of OSHA 300 and 300A<br>available for review?

  Yes

  No

  N/A

• Are the OSHA 300 and 300A completed<br>properly? (no blank spaces, signatures,<br>numbers total correctly, etc.)

  Yes

  No

  N/A

• Would you like to review training?

  Yes

  No

  N/A

Physical Hazard Walk - around

• Physical Hazard Walk-around:

• Add a hazard

Hazard

• Briefly describe the hazard

• Pictures of the hazard and / or solution

  Media

• What is the severity of the injury that could occur? (1 = minor, 10 = fatality?

• Propose solution and implementation date

Behavior Safety Observations

• Behavior Safety Observations

Observations

• Observe Teammate Working. look for small unsafe decisions, short cuts, improper ways of performing the task, or other risks that may lead to an incident. Discuss at-risk findings with teammate.
  
  Do not include the teammates name in this observations.

• Explain any Safe or Best Practice Behaviors Observed

• Are there best practice that deserve awareness from this location?

  No

  Yes

  N/A

Site Culture KPI

• Would you like to measure the culture at this location?

  No

  Yes

  N/A

• Rank the locations on the following 10 categories. 10 = Perfect, 5 = average, 0 = non - existent). These scores should be through observations and discussions about safety & health and only minimally influenced by single unsafe conditions identified through a walk around.

• Does the leadership team at the location show a visible commitment to safety and the well being of the teammates?

• Are teammates engaged in helping improve safety or do employees regularly make unsafe decisions despite proper training and coaching?

• How well does your safety process handle hazard recognition, incident root cause and lessons learned? How does your site handle safety suggestions, identified risks, training tracking, and other safety information being input to the system?

• How well do the leadership team and the employees identify and prevent hazards from becoming injuries? Is there a process in place to identify, control and communicate the hazards in the production areas?

• How well does management communicate to employees about safety and how well do they communicate back about safety? Do employees have the courage to speak up to the management team at the site?

• How well do you manage major changes in the workplace (i.e. moving an operation, new equipment, electrical updates/changes, etc.)? Are there a lot of upset conditions and surprises throughout the project?

• How well does the site manage incidents when they do happen (reporting to Safety Dept., drug testing, clinics, incident reports, root cause analysis, etc.)?

• How well does your site coach and train employees that need it? Does the site do well identifying employees who need training and coaching before they get themselves into trouble?

• Do you call upon those resources and ask how they’ve already solved the problem or do you just try to solve it in vacuum? This may include the Safety Department, fellow site managers, corporate, etc.

• Are employees terminated on their first minor offense (1) or are employees allowed to get away with anything (also a 1). Does your site have a clearly documented and followed approach to progressive discipline?

• Additional Comments (Optional):

• Where there findings from this audit discussed. in person with the site manager before leaving?

  No

  Yes

  N/A

• Where there any of the findings during this visit duplicates from the last visit (optional)

  No

  Yes

  N/A

• Additional comments from visit (optional)

• Next estimated audit date: