Information
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Document No.
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Audit Title
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Conducted on
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Prepared by
Office
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Floor mats in good condition?
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Electric, phone cords minimized/properly covered?
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Drawers & file cabinets properly closed?
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Adequate housekeeping?
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Trash emptied daily?
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No tripping hazards, wet spots, protruding objects?
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#1 Fire extinguisher- tagged/charged/inspected/accessible?
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#2 Fire extinguisher- tagged/charged/inspected/accessible?
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#3 Fire extinguisher- tagged/charged/inspected/accessible?
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Emergency exit #1 correctly marked and accessible (main entrance)?
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Emergency exit #2 correctly marked and accessible (west side)?
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Emergency lighting operational? (9 units)
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Exit signs lit?
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Electrical outlets in good condition?
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Other items?
item
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item?
Route Sales Office
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Floor mats in good condition?
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Electric, phone cords minimized/properly covered?
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Drawers & file cabinets properly closed?
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Adequate housekeeping?
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Trash emptied daily?
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Are doorways clear?
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No tripping hazards, wet spots, protruding objects?
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Electrical outlets in good condition?
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Other items?
item
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item?
Kitchen/Lunchroom Area
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Floor mats in good condition?
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Wiring ok (no exposed wires, frayed cords)?
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Adequate housekeeping?
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GFCIs pass push test?
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#5 Fire extinguisher- tagged/charged/inspected/accessible?
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Lunchroom exit sign lit?
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Electrical outlets in good condition?
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Other items?
item
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item?
Co-orkers Entrance?
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Emergency exit #3 correctly marked and accessible?
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#4 Fire extinguisher- tagged/charged/inspected/accessible?
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November 1- May 1, salt available?
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Other items?
item
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item?
First Aid Room?
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AED Charged and inspected?
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First aid supplies adequate?
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1"x3" Bandages (Check box only if needed)
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Please order.
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2"x2" Gauze Pads (Check box only if needed)
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Please order.
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Burn Ointment (Check box only if needed)
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Please order.
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Eye Wash Solution (Check box only if needed)
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Please order.
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Ice Pack (Check box only if needed)
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Please order.
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Instant Cold Spray (Check box only if needed)
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Please order.
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Scissors (Check box only if needed)
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Please order.
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Adequate housekeeping?
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Incident/Accident Reports availabe?
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Electrical outs in good condition?
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Other items?
item
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item?
Front Dock Area
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No slip, trip or fall hazzards?
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Steps, railings walk way clean and free from obstruction?
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Railings intact and secured?
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Adequate housekeeping?
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Emergency exit #5 correctly marked and accessible?
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November 1- May 1, salt spreader available?
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#6 Fire extinguisher- tagged/charged/inspected/accessible?
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Door #5 exit sign lit?
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Electrical junction boxes in good condition/properly protected?
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Other items?
item
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item?
Green Zone
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Floor clean and dry, free from slip, trip or fall hazards?
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Electrical panel boxes labeled and closed?
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Adequate housekeeping?
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Emergency exit #4 correctly marked and accessible?
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#9 Fire extinguisher- tagged/charged/inspected/accessible?
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Eye wash station clean and operational?
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#7 Fire extinguisher- tagged/charged/inspected/accessible?
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#8 Fire extinguisher- tagged/charged/inspected/accessible?
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Other items?
item
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item?
Mending/Sorting/Press Area
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Floor clean and dry?
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Electrical equipment properly grounded?
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Wiring ok (no exposed wires, frayed cords)?
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Chain guard in place?
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#10 Fire extinguisher- tagged/charged/inspected/accessible?
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#11 Fire extinguisher- tagged/charged/inspected/accessible?
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Adequate housekeeping?
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Other items?
item
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item?
Mechanical Room
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Floors clean and dry?
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Floor free of slip, trip and fall hazards?
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Adequate housekeeping?
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Exit doors identified and clear of obstacles?
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No steam/air/water leaks?
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Eye wash station/emergency shower clean and operational?
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#12 Fire extinguisher- tagged/charged/inspected/accessible?
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#13 Fire extinguisher- tagged/charged/inspected/accessible?
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Other items?
item
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item?
Tunnel Hanging Area
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Floor mats in good condition?
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Adequate housekeeping?
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#17 Fire extinguisher- tagged/charged/inspected/accessible?
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Other items?
item
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item?
Tunnel Mezzanine Area
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Access Chain to mezzanine restricting access?
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Mezzanine stairs clean with no obstructions?
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Mezzanine railings intact and decking checked for tripping hazards?
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#16 Fire extinguisher- tagged/charged/inspected/accessible?
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Other items?
item
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item?
Wash Aisle
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Floors free from slip, trip and fall hazards?
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Adequate housekeeping?
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Chemical containers properly labeled with specific hazards and are closed/sealed?
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Chemical containers properly secured?
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Chemical delivery system free of leaks?
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Walkway behind Ellis washers clean & free of tripping hazards?
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PPE provided as required?
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MSDS readily available for all products used in this area?
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Eye wash/shower station cleean, capped tagged, functional, free of obstructions?
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Lockout/Tagout board supplied, locks accounted for?
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Pits and drain covers in place?
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#14 Fire extinguisher- tagged/charged/inspected/accessible?
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#15 Fire extinguisher- tagged/charged/inspected/accessible?
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#17 Fire extinguisher- tagged/charged/inspected/accessible?
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#18 Fire extinguisher- tagged/charged/inspected/accessible?
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#19 Fire extinguisher- tagged/charged/inspected/accessible?
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#21 Fire extinguisher- tagged/charged/inspected/accessible?
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Rolling ladders have rubber stoppers on drop legs?
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Electrical control box on conveyer 5.4 closed? (Check box only if needed)
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Machine guards properly installed?
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Emergency stops operational?
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Water/sprinkler valves
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Other items?
item
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item?
Stockroom
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Floor mats in good condition?
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Electric, phone cords minimized/properly covered?
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Adequate housekeeping?
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Floor free of slip, trip and fall hazards?
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Drawers & file cabinets properly closed?
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#20 Fire extinguisher- tagged/charged/inspected/accessible?
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Emergency exit #6 correctly marked and accessible?
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Machine guards in place?
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Other items?
item
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item?
Mat Folding/Rolling Area
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Floor free of slip, trip and fall hazards?
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Mat conveyer operational with guards in place?
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Electrical panel accessible with 3' clearance on both sides?
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Other items?
item
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item?
Maintenance Shop
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Shop equipment properly guarded and in good working order?
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PPE provided as required?
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Combustible materials stored safely?
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Emergency exit #8 correctly marked and accessible?
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No open containers unless in use?
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#28 Fire extinguisher- tagged/charged/inspected/accessible?
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#29 Fire extinguisher- tagged/charged/inspected/accessible?
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Other items?
item
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item?
Truck Garage/Loading & Unloading Area
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Floor free of slip, trip and fall hazards?
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Emergency exit #7 correctly marked and accessible?
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Safety containers used for combustible in good working order?
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Full and empty propane tanks properly secured?
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Are propane tanks stored away from hat sources of ignition?
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#23 Fire extinguisher- tagged/charged/inspected/accessible?
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#24 Fire extinguisher- tagged/charged/inspected/accessible?
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#25 Fire extinguisher- tagged/charged/inspected/accessible?
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Emergency exit #9 correctly marked and accessible? (north wall)
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Forklift #1 and #2 inspected daily?
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All forklift equipment functions properly-brakes, horn, controls, backup alarm?
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All forklift equipment functions properly-brakes, horn, controls, backup alarm?
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Forklift seat belts used?
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Are broken pallets removed from service and stored separately?
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Are empty pallets stored flat?
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Other items?
item
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item?
Rear Garage
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Floor free of slip, trip and fall hazards?
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#26 Fire extinguisher- tagged/charged/inspected/accessible?
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#27 Fire extinguisher- tagged/charged/inspected/accessible?
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Other items?
item
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item?
Fire Pump House
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Floor free of slip, trip and fall hazards?
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#30 Fire extinguisher- tagged/charged/inspected/accessible?
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Valves and gauges not leaking?
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Fire pump started?
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Other items?
item
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item?
Parking Lot and Grounds
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All exits free of obstructions?
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Walkways clear?
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Broken glass or metal objects
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Other items?
item
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item?
Other Items
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Is OSHA posted displayed where Co-Workers can see it?
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Is OSHA 300 log available? February 1st - April 30th
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Are emergency phone numbers posted?
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Open electrical junction boxes properly covered?
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Electrical panel boxes marked to indicate service and voltage?
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Electrical panels have 3' clearance each side?
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Adequate lighting in all areas?
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Extension cords in good condition? (not taped or broken)
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Extension cords grounded with 3 prongs?
Notes and Signature Page
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Remarks/Comments
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Audit Completed By?
PPE Storage Cabinet Inventory
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Safety Glasses (Emedco.com)
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Safety Goggles (Emedco.com)
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Headgear for face shield (LSS.com) product # 6635-3
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Chemical resistant replacement face shield (LSS.com) product # 6635-2
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Metal lens cleaning station (LSS.com) product # 54621
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Lens cleaning tissues (LSS.com) product # 962
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Rubber coated cloth apron 27"x36" (LSS.com) product # 926-1
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Back support size small (Tuffrhino.com) product # GS2065
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Back support size medium (Tuffrhino.com) product # GS2065
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Back support size large (Tuffrhino.com) product # GS2065
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Back support size xlarge (Tuffrhino.com) product # GS2065
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Back support size 2xlarge (Tuffrhino.com) product # GS2065
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Back support size 3xlarge (Tuffrhino.com) product # GS2065
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Lab coat 46rg (Red Kap) product # KP14NV
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Lab coat 50rg (Red Kap) product # KP14NV
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Lab coat 54rg (Red Kap) product # KP14NV
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Coverall 46rg (Red Kap) product # CT10NV
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Coverall 50rg (Red Kap) product # CT10NV
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Coverall 54rg (Red Kap) product # CT10NV
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Nitrile gloves medium (boxes)
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Nitrile gloves medium (boxes)
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Nitrile gloves large (boxes)
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Nitrile gloves xlarge (boxes)
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Cellulose sweatbands (Occunomix.com) 100/pkg
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Dust masks (Emedco.com) 50/box
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Ear plugs (Emedco.com) 200/box
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Miracool bandanas (Occunomix.com)
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Date Inventoried?
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Inventoried by?
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Emedco.com
http://www.emedco.com -
LSS.com
http://www.grainger.com/Grainger/wwg/start.shtml?r=l&cm_mmc=LabSafety-_-Integration-_-AllPages-_-AllPages -
Tuffrhino.com
http://www.tuffrhino.com/Default.asp -
Occunomix.com
http://www.occunomix.com -
Redkap.com
http://www.redkap.com