DC 5200 - MOD Audit - duplicate

• Site conducted

  Select

• Conducted on

  Date

• Prepared by:

Floor 1

• Is there any grating that is missing?

  Yes

  No

  N/A

• Are any areas blocked?

  Yes

  No

  N/A

• Are the pallet returns blocked or overloaded with pallets?

  Yes

  No

  N/A

• Rate the Cleanliness of this floor

  Select Great Good Fair Poor-Safety Hazard Bad-Safety Hazard N/A

  • Great
  • Good
  • Fair
  • Poor-Safety Hazard
  • Bad-Safety Hazard
  • N/A

Floor 2

• Is there any grating that is missing?

  Yes

  No

  N/A

• Are any areas blocked?

  Yes

  No

  N/A

• Are the pallet returns blocked or overloaded with pallets?

  Yes

  No

  N/A

• Rate the Cleanliness of this floor

  Select Great Good Fair Poor-Safety Hazard Bad-Safety Hazard N/A

  • Great
  • Good
  • Fair
  • Poor-Safety Hazard
  • Bad-Safety Hazard
  • N/A

Floor 3

• Is there any grating that is missing?

  Yes

  No

  N/A

• Are any areas blocked?

  Yes

  No

  N/A

• Are the pallet returns blocked or overloaded with pallets?

  Yes

  No

  N/A

• Rate the Cleanliness of this floor

  Select Great Good Fair Poor-Safety Hazard Bad-Safety Hazard N/A

  • Great
  • Good
  • Fair
  • Poor-Safety Hazard
  • Bad-Safety Hazard
  • N/A

Floor 4

• Is there any grating that is missing?

  Yes

  No

  N/A

• Are any areas blocked?

  Yes

  No

  N/A

• Are the pallet returns blocked or overloaded with pallets?

  Yes

  No

  N/A

• Rate the Cleanliness of this floor

  Select Great Good Fair Poor-Safety Hazard Bad-Safety Hazard N/A

  • Great
  • Good
  • Fair
  • Poor-Safety Hazard
  • Bad-Safety Hazard
  • N/A

Pallet Stoppers

• Are any of the pallet stoppers damaged?

  Yes

  No

  N/A

Floor 1

• Is there any grating that is missing?

  Yes

  No

  N/A

• Are any areas blocked?

  Yes

  No

  N/A

• Are the pallet returns blocked or overloaded with pallets?

  Yes

  No

  N/A

• Rate the Cleanliness of this floor

  Select Great Good Fair Poor-Safety Hazard Bad-Safety Hazard N/A

  • Great
  • Good
  • Fair
  • Poor-Safety Hazard
  • Bad-Safety Hazard
  • N/A

Floor 2

• Is there any grating that is missing?

  Yes

  No

  N/A

• Are any areas blocked?

  Yes

  No

  N/A

• Are the pallet returns blocked or overloaded with pallets?

  Yes

  No

  N/A

• Rate the Cleanliness of this floor

  Select Great Good Fair Poor-Safety Hazard Bad-Safety Hazard N/A

  • Great
  • Good
  • Fair
  • Poor-Safety Hazard
  • Bad-Safety Hazard
  • N/A

Floor 3

• Is there any grating that is missing?

  Yes

  No

  N/A

• Are any areas blocked?

  Yes

  No

  N/A

• Are the pallet returns blocked or overloaded with pallets?

  Yes

  No

  N/A

• Rate the Cleanliness of this floor

  Select Great Good Fair Poor-Safety Hazard Bad-Safety Hazard N/A

  • Great
  • Good
  • Fair
  • Poor-Safety Hazard
  • Bad-Safety Hazard
  • N/A

Floor 4

• Is there any grating that is missing?

  Yes

  No

  N/A

• Are any areas blocked?

  Yes

  No

  N/A

• Are the pallet returns blocked or overloaded with pallets?

  Yes

  No

  N/A

• Rate the Cleanliness of this floor

  Select Great Good Fair Poor-Safety Hazard Bad-Safety Hazard N/A

  • Great
  • Good
  • Fair
  • Poor-Safety Hazard
  • Bad-Safety Hazard
  • N/A

Pallet Stoppers

• Are any of the pallet stoppers damaged?

  Yes

  No

  N/A

Floor 1

• Is there any grating that is missing?

  Yes

  No

  N/A

• Are any areas blocked?

  Yes

  No

  N/A

• Are the pallet returns blocked or overloaded with pallets?

  Yes

  No

  N/A

• Rate the Cleanliness of this floor

  Select Great Good Fair Poor-Safety Hazard Bad-Safety Hazard N/A

  • Great
  • Good
  • Fair
  • Poor-Safety Hazard
  • Bad-Safety Hazard
  • N/A

Floor 2

• Is there any grating that is missing?

  Yes

  No

  N/A

• Are any areas blocked?

  Yes

  No

  N/A

• Are the pallet returns blocked or overloaded with pallets?

  Yes

  No

  N/A

• Rate the Cleanliness of this floor

  Select Great Good Fair Poor-Safety Hazard Bad-Safety Hazard N/A

  • Great
  • Good
  • Fair
  • Poor-Safety Hazard
  • Bad-Safety Hazard
  • N/A

Floor 3

• Is there any grating that is missing?

  Yes

  No

  N/A

• Are any areas blocked?

  Yes

  No

  N/A

• Are the pallet returns blocked or overloaded with pallets?

  Yes

  No

  N/A

• Rate the Cleanliness of this floor

  Select Great Good Fair Poor-Safety Hazard Bad-Safety Hazard N/A

  • Great
  • Good
  • Fair
  • Poor-Safety Hazard
  • Bad-Safety Hazard
  • N/A

Floor 4

• Is there any grating that is missing?

  Yes

  No

  N/A

• Are any areas blocked?

  Yes

  No

  N/A

• Are the pallet returns blocked or overloaded with pallets?

  Yes

  No

  N/A

• Rate the Cleanliness of this floor

  Select Great Good Fair Poor-Safety Hazard Bad-Safety Hazard N/A

  • Great
  • Good
  • Fair
  • Poor-Safety Hazard
  • Bad-Safety Hazard
  • N/A

Pallet Stoppers

• Are any of the pallet stoppers damaged?

  Yes

  No

  N/A

Floor 1

• Is there any grating that is missing?

  Yes

  No

  N/A

• Are any areas blocked?

  Yes

  No

  N/A

• Are the pallet returns blocked or overloaded with pallets?

  Yes

  No

  N/A

• Rate the Cleanliness of this floor

  Select Great Good Fair Poor-Safety Hazard Bad-Safety Hazard N/A

  • Great
  • Good
  • Fair
  • Poor-Safety Hazard
  • Bad-Safety Hazard
  • N/A

Floor 2

• Is there any grating that is missing?

  Yes

  No

  N/A

• Are any areas blocked?

  Yes

  No

  N/A

• Are the pallet returns blocked or overloaded with pallets?

  Yes

  No

  N/A

• Rate the Cleanliness of this floor

  Select Great Good Fair Poor-Safety Hazard Bad-Safety Hazard N/A

  • Great
  • Good
  • Fair
  • Poor-Safety Hazard
  • Bad-Safety Hazard
  • N/A

Floor 3

• Is there any grating that is missing?

  Yes

  No

  N/A

• Are any areas blocked?

  Yes

  No

  N/A

• Are the pallet returns blocked or overloaded with pallets?

  Yes

  No

  N/A

• Rate the Cleanliness of this floor

  Select Great Good Fair Poor-Safety Hazard Bad-Safety Hazard N/A

  • Great
  • Good
  • Fair
  • Poor-Safety Hazard
  • Bad-Safety Hazard
  • N/A

Floor 4

• Is there any grating that is missing?

  Yes

  No

  N/A

• Are any areas blocked?

  Yes

  No

  N/A

• Are the pallet returns blocked or overloaded with pallets?

  Yes

  No

  N/A

• Rate the Cleanliness of this floor

  Select Great Good Fair Poor-Safety Hazard Bad-Safety Hazard N/A

  • Great
  • Good
  • Fair
  • Poor-Safety Hazard
  • Bad-Safety Hazard
  • N/A

Pallet Stoppers

• Are any of the pallet stoppers damaged?

  Yes

  No

  N/A

• Were the Shepherd's hooks misplaced?

  Yes

  No

  N/A

• Anything else to add regarding this MOD Audit?

  Yes

  No

  N/A