Doritex Safety Audit

• Document No.

• Audit Title

• Conducted on

  Date

• Prepared by:

• Emergency exit #1 correctly marked and accessible (main entrance)?

  Yes

  No

  N/A

• Exit light #4X lit and working properly? (Above Main Entrance)

  Yes

  No

  N/A

• Fire Extinguisher #1 - Front Lobby Seating Area

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Emergency lighting #1E operational? (Entrance to Mailroom facing Front Desk)

  Yes

  No

  N/A

• Emergency lighting #2E operational? (Front Lobby Seating Area)

  Yes

  No

  N/A

• Are floor mats in good condition?

  Yes

  No

• Electric, phone cords minimized/properly covered?

  Yes

  No

• Are all filing cabinet drawers properly closed and filled from the bottom?

  Yes

  No

  N/A

• Adequate housekeeping?

  Good

  Fair

  Poor

• Trash emptied daily?

  Yes

  No

  N/A

• Emergency lighting #3E operational? (Outside of HR Office)

  Yes

  No

  N/A

• Exit light #5X lit and working properly? (Outside of Office Managers Office)

  Yes

  No

  N/A

• Emergency lighting #4E operational? (Above Team Leader's Desk)

  Yes

  No

  N/A

• No tripping hazards, wet spots, protruding objects?

  Yes

  No

  N/A

• Emergency lighting #10E operational? (Above Fitness Room Door's)

  Yes

  No

  N/A

• Fire Extinguisher #2 - Fitness Room Hallway

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Emergency lighting #5E operational? (Outside of Sales Manager's Office)

  Yes

  No

  N/A

• Emergency lighting #7E operational? (Above Hallway Entrance Outside of Training Room)

  Yes

  No

  N/A

• Exit light #6X lit and working properly? (In front of hallway leading to Exit #2)

  Yes

  No

  N/A

• Fire Extinguisher #3 - Hallway near Training Room

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Emergency lighting #6E operational? (Mid-Hallway Near Exit #2)

  Yes

  No

  N/A

• Emergency exit #2 correctly marked and accessible (west side)?

  Yes

  No

  N/A

• Emergency lighting & exit combo #4EE operational? (Above Exit #2)

  Yes

  No

  N/A

• Emergency lighting #8E operational? (Plant Entrance Near Training Room)

  Yes

  No

  N/A

• Electrical outlets in good condition?

  Yes

  No

  N/A

• Misc. violation or issues

  Media

• Violation:

• Emergency lighting #9E operational? (Above Training Room Entrance/Exit)

  Yes

  No

  N/A

• Adequate housekeeping?

  Good

  Fair

  Poor

• Floor mats in good condition?

  Yes

  No

• Electric, phone cords minimized/properly covered?

  Yes

  No

• Drawers & file cabinets properly closed?

  Yes

  No

  N/A

• Adequate housekeeping?

  Good

  Fair

  Poor

• Trash emptied daily?

  Yes

  No

  N/A

• Are doorways clear?

  Yes

  No

  N/A

• No tripping hazards, wet spots, protruding objects on the floor?

  Yes

  No

  N/A

• Electrical outlets in good condition?

  Yes

  No

  N/A

• Misc. violation or issues

  Media

• Violation:

• Exit light #3X lit and working properly? (In Hallway above Co Worker Entrance/Exit)

  Yes

  No

  N/A

• Emergency exit #3 correctly marked and accessible?

  Yes

  No

  N/A

• Fire Extinguisher #4 - Co-Worker Entrance

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• November 1- May 1, salt available?

  Yes

  No

  N/A

• November 1- May 1, winter 2x3 mat in-between the logo mat and door?

  Yes

  No

  N/A

• Misc. violation or issues

  Media

• Violation:

• Floor mats in good condition?

  Yes

  No

• Wiring ok (no exposed wires, frayed cords)?

  Yes

  No

  N/A

• Adequate housekeeping?

  Good

  Fair

  Poor

• GFCIs pass push test?

  Yes

  No

  N/A

• Exit light #2X lit and working properly? (Near Co-Worker Entrance)

  Yes

  No

  N/A

• Electrical outlets in good condition?

  Yes

  No

  N/A

• Fire Extinguisher #5 - Near First Aid Room Door

  Okay

  Improper Charge

  Missing Inspection Tag

  Missing Pull Pin Tag

  Blocked/Missing

• Misc. violation or issues

  Media

• Violation:

• AED Charged and inspected?

  Yes

  No

  N/A

• Oxygen Tank fully charged, inspected, and secured in the cabinet?

  Yes

  No

• First aid supplies adequate?

  Yes

  No

  N/A

• 1"x3" Bandages (Check box only if needed)

• Please order.

• 2"x2" Gauze Pads (Check box only if needed)

• Please order.

• Burn Ointment (Check box only if needed)

• Please order.

• Eye Wash Solution (Check box only if needed)

• Please order.

• Ice Pack (Check box only if needed)

• Please order.

• Instant Cold Spray (Check box only if needed)

• Please order.

• Scissors (Check box only if needed)

• Please order.

• Adequate housekeeping?

  Good

  Fair

  Poor

• Incident/Accident Reports availabe?

  Yes

  No

  N/A

• Electrical outs in good condition?

  Yes

  No

  N/A

• Misc. violation or issues

  Media

• Violation:

• Fire Extinguisher #7 - Near the Time Clock

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Is OSHA 300 log available? February 1st - April 30th

  Yes

  No

  N/A

• Floor clean and dry, free from slip, trip or fall hazards?

  Yes

  No

  N/A

• Electrical panel boxes labeled and closed?

  Yes

  No

  N/A

• Adequate housekeeping?

  Good

  Fair

  Poor

• Fire Extinguisher #8 - Office/Plant Door near Eye Wash Station

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Emergency exit #4 correctly marked and accessible?

  Yes

  No

  N/A

• Exit light #7X lit and working properly? (Near exit #4)

  Yes

  No

  N/A

• Fire Extinguisher #9 - Near Exit Door #4

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Eye wash/shower station clean, capped, functional, & free of obstructions?

  Yes

  No

  N/A

• Are the ladders safe and free of any hazards?

  Yes

  No

  N/A

• Misc. violation or issues

  Media

• Violation:

• Lens Cleaning Station Available?

  Yes

  No

• Is it stocked with Tissues (on Bottom of the Box)?

  Yes

  No

• Is the Cleaner Spray available (on Top of the Box)?

  Yes

  No

• Dust Masks Available?

  Yes

  No

• Sharps Container Less than 75% full?

  Yes

  No

• Secondary Bottle Labels?

  Yes

  No

• Sign-Out sheet less than 3/4 or more than one available?

  Yes

  No

• Face Shield?

  Yes

  No

• Is it clean and in full working condition?

  Yes

  No

• Splash Goggles?

  Yes

  No

• At least 3 pairs of Safety Glasses?

  Yes

  No

• Rubber Coated Apron?

  Yes

  No

• Small Back Support Belt Available?

  Yes

  No

• Medium Back Support Belt Available?

  Yes

  No

• Large Back Support Belt Available?

  Yes

  No

• X-Large Back Support Belt Available?

  Yes

  No

• 2X Back Support Belt Available?

  Yes

  No

• Lab Coat 46 RG?

  Yes

  No

• Lab Coat 50 RG?

  Yes

  No

• Lab Coat 54 RG?

  Yes

  No

• Coverall 46 RG?

  Yes

  No

• Coverall 50 RG?

  Yes

  No

• Coverall 54 RG?

  Yes

  No

• Reflective Coat (Green)?

  Yes

  No

• Small Nitrile Gloves?

  Yes

  No

• Medium Nitrile Gloves?

  Yes

  No

• Large Nitrile Gloves?

  Yes

  No

• X-Large Nitrile Gloves?

  Yes

  No

• Sweatbands?

  Yes

  No

• Ear Plugs Available (In box on bottom)?

  Yes

  No

• Is the PPE Cabinet clean and free of dust and dirt?

  Yes

  No

• Misc. violation or issues

  Media

• Violation:

• No slip, trip or fall hazzards?

  Yes

  No

  N/A

• Steps, railings walk way clean and free from obstruction?

  Yes

  No

  N/A

• Railings intact and secured?

  Yes

  No

  N/A

• Adequate housekeeping?

  Good

  Fair

  Poor

• Emergency exit #5 correctly marked and accessible?

  Yes

  No

  N/A

• Fire Extinguisher #6 - Front Loading Dock by Exit #5

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Door #5 exit sign lit?

  Yes

  No

  N/A

• Exit light #1X lit and working properly? (Above Exit #5)

  Yes

  No

  N/A

• Electrical junction boxes in good condition/properly protected?

  Yes

  No

  N/A

• November 1- May 1, salt spreader available?

  Yes

  No

  N/A

• Misc. violation or issues

  Media

• Violation:

• Are the floors clean, dry, and free of any tripping hazards?

  Yes

  No

  N/A

• Electrical equipment properly grounded?

  Yes

  No

  N/A

• Wiring ok (no exposed wires, frayed cords)?

  Yes

  No

  N/A

• Chain guard in place?

  Yes

  No

  N/A

• Adequate housekeeping?

  Good

  Fair

  Poor

• Is the fan guard

  Yes

  No

  N/A

• Misc. violation or issues

  Media

• Violation:

• Fire Extinguisher #11 - Next To Chain Outside of the Boiler Room Door

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Fire Extinguisher #12 - Next to Chain Inside the Boiler Room

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Floors clean and dry?

  Yes

  No

  N/A

• Floor free of slip, trip and fall hazards?

  Yes

  No

  N/A

• Adequate housekeeping?

  Good

  Fair

  Poor

• Is the chain up restricting access when the area is not in use?

  Yes

  No

• Exit doors identified and clear of obstacles?

  Yes

  No

  N/A

• No steam/air/water leaks?

  Yes

  No

  N/A

• Eye wash/shower station clean, capped, functional, & free of obstructions?

  Yes

  No

  N/A

• Flammable Materials stored in cabinet when not in use?

  Yes

  No

• Ladder not in use chained to the Wall?

  Yes

  No

• Fire Extinguisher #13 - Back Corner of Boiler Room near Eye Wash Station

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Misc. violation or issues

  Media

• Violation:

• Fire Extinguisher #14 - Outside the Boiler Room Door across from the Washers

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Floors free from slip, trip and fall hazards?

  Yes

  No

  N/A

• Adequate housekeeping?

  Good

  Fair

  Poor

• Fire Extinguisher #15 - Water Can near small washers

  Okay

  Improper Charge

  Missing Inspection Tag

  Missing Pull Pin Tag

  Blocked/Missing

• Chemical containers properly labeled with specific hazards and are closed/sealed?

  Yes

  No

  N/A

• Chemical containers properly secured?

  Yes

  No

  N/A

• Chemical delivery system free of leaks?

  Yes

  No

  N/A

• Walkway behind Ellis washers clean & free of tripping hazards?

  Yes

  No

  N/A

• PPE provided as required?

  Yes

  No

• MSDS readily available for all products used in this area?

  Yes

  No

  N/A

• Wash Aisle concerns/comments/unsafe conditions (Ask Operator)?

  No

  Yes

• Eye wash/shower station clean, capped, functional, & free of obstructions?

  Yes

  No

  N/A

• Lockout/Tagout board supplied, locks accounted for?

  Yes

  No

  N/A

• Pits and drain covers in place?

  Yes

  No

  N/A

• Sharps Container Less than 75% full?

  Yes

  No

• Fire Extinguisher #15 - In Wash Aisle on the pole near the desk

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Fire Extinguisher #17 - On the back side of the Dryers

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Fire Extinguisher #21 - Near Sling Lift across from Mat Repair

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Rolling ladders have rubber stoppers on drop legs?

  Yes

  No

  N/A

• Electrical control box on conveyer 5.4 closed? (Check box only if needed)

  Yes

  No

  N/A

• Machine guards properly installed?

  Yes

  No

  N/A

• Emergency stops operational?

  Yes

  No

  N/A

• Water/sprinkler valves

  Yes

  No

  N/A

• Misc. violation or issues

  Media

• Violation:

• Adequate housekeeping?

  Good

  Fair

  Poor

• Chemical containers properly labeled with specific hazards and are closed/sealed?

  Yes

  No

  N/A

• Flammable Materials stored in cabinet when not in use?

  Yes

  No

• Are all box cutters stored safe with no exposed blade?

  Yes

  No

• PPE provided as required?

  Yes

  No

• Floor mats in good condition?

  Yes

  No

  N/A

• Adequate housekeeping?

  Good

  Fair

  Poor

• Safety Glasses present near every air hose?

  Yes

  No

• Ladder not in use chained to the Wall?

  Yes

  No

  N/A

• Misc. violation or issues

  Media

• Violation:

• Access Chain to mezzanine restricting access?

  Yes

  No

  N/A

• Mezzanine stairs clean with no obstructions?

  Yes

  No

  N/A

• Mezzanine railings intact and decking checked for tripping hazards?

  Yes

  No

  N/A

• Fire Extinguisher #16 - On Mezzanine

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Misc. violation or issues

  Media

• Violation:

• Emergency lighting #12E operational? (Men's Bathroom in Plant)

  Yes

  No

  N/A

• Emergency lighting #11E operational? (Women's Bathroom in Plant)

  Yes

  No

  N/A

• Fire Extinguisher #10 - Near Electrical Panels Across from Sorting

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Fire Extinguisher #18 - Around the corner from the Office Door (Bathroom Wall Side)

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Fire Extinguisher #19 - Near Drinking Fountains by Bathroom Doors

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Sharp Container less than 75% Full?

  Yes

  No

• Misc. violation or issues

  Media

• Violation:

• Floor mats in good condition?

  Yes

  No

• Electric, phone cords minimized/properly covered?

  Yes

  No

• Adequate housekeeping?

  Good

  Fair

  Poor

• Floor free of slip, trip and fall hazards?

  Yes

  No

  N/A

• Drawers & file cabinets properly closed?

  Yes

  No

  N/A

• Fire Extinguisher #20 - Across from Embroidery Room Door

  Okay

  Improper Charge

  Missing Inspection Tag

  Missing Pull Pin Tag

  Blocked/Missing

• Emergency exit #6 correctly marked and accessible?

  Yes

  No

  N/A

• Sewing machine guards in place?

  Yes

  No

  N/A

• Misc. violation or issues

  Media

• Violation:

• Emergency lighting & exit combo #2EE operational? (Above Entrance to the Embroidery Room Door)

  Yes

  No

  N/A

• Emergency exit #6 correctly marked and accessible?

  Yes

  No

  N/A

• Emergency lighting & exit combo #3EE operational? (Above Exit #6)

  Yes

  No

  N/A

• Misc. violation or issues

  Media

• Violation:

• Floor free of slip, trip and fall hazards?

  Yes

  No

  N/A

• Mat conveyer operational with guards in place?

  Yes

  No

  N/A

• Electrical panel accessible with 3' clearance on both sides?

  Yes

  No

  N/A

• Sharps Container Less than 75% full?

  Yes

  No

• Misc. violation or issues

  Media

• Violation:

• Fire Extinguisher #22 - Right Outside the Maintenance Shop Door

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Shop equipment properly guarded and in good working order?

  Yes

  No

  N/A

• Are the grinding wheels within the acceptable 1/18 of an inch gap?

  Yes

  No

• Combustible materials stored safely?

  Yes

  No

  N/A

• Emergency exit #8 correctly marked and accessible?

  Yes

  No

  N/A

• Emergency lighting & exit combo #1EE operational? (Above Exit #8)

  Yes

  No

  N/A

• No open containers unless in use?

  Yes

  No

  N/A

• Fire Extinguisher #29 - In-between both Entrances/Exits

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Ladder not in use chained to the Wall?

  Yes

  No

• Are the Water Sprinklers being blocked by anything? (Closer than 18")

  Safe

  At Risk

  N/A

• Are the Harnesses being inspected before use?

  Yes

  No

• Are the Arc Flash Gloves OPENED, and if so are they inspected within the last 6 months?

  No

  Yes

• Flammable Material Cabinet free from clutter and closed?

  Safe

  At Risk

  N/A

• Fire Extinguisher #27 - Under Phil's Desk (Spare)

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Fire Extinguisher #28 - Under Phil's Desk (Spare #2)

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Fire Extinguisher #? - Under Phil's Desk (Spare #3)

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Misc. violation or issues

  Media

• Violation:

• Floor free of slip, trip and fall hazards?

  Yes

  No

  N/A

• Emergency exit #7 correctly marked and accessible?

  Yes

  No

  N/A

• Exit light #9X lit and working properly? (Near exit #7)

  Yes

  No

  N/A

• Safety containers used for combustible in good working order?

  Yes

  No

  N/A

• Fire Extinguisher #23 - On Pole near Bulk Storage

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Fire Extinguisher #24 - Near Stockroom Entrance from the garage area

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Emergency exit #9 correctly marked and accessible? (north wall)

  Yes

  No

  N/A

• Exit light #8X lit and working properly? (Near exit #9)

  Yes

  No

  N/A

• Forklift #1 inspected daily?

  Yes

  No

• Forklift #1 seat belt being used/ key out of the ignition if not in use?

  Yes

  No

• Fire Extinguisher Forklift #1

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Forklift #2 inspected daily?

  Yes

  No

• Forklift #2 seat belt being used/ key out of the ignition if not in use?

  Yes

  No

• Fire Extinguisher Forklift #2

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Fire Extinguisher #25 - Truck Garage Near Door #7

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Are broken pallets removed from service and stored separately?

  Yes

  No

  N/A

• Are empty pallets stored flat?

  Yes

  No

  N/A

• Fire Extinguisher Scissor Lift

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Fire Extinguisher Large Welding Cart

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Fire Extinguisher Small Welding Cart

  Okay

  Improper Charge

  Missing Inspection Tag

  Missing Pull Pin Tag

  Blocked/Missing

• Misc. violation or issues

  Media

• Violation:

• Floor free of slip, trip and fall hazards?

  Yes

  No

  N/A

• Fire Extinguisher #26 - In-between Entrance and Garage Door

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Misc. violation or issues

  Media

• Violation:

• Fire Extinguisher #30 - To the right of the Enterance

  Select Okay Improper Charge Missing Inspection Tag Missing Pull Pin Tag Blocked/Missing

  • Okay
  • Improper Charge
  • Missing Inspection Tag
  • Missing Pull Pin Tag
  • Blocked/Missing

• Floor free of slip, trip and fall hazards?

  Yes

  No

  N/A

• Valves and gauges not leaking?

  Yes

  No

  N/A

• Fire pump started?

  Yes

  No

  N/A

• Misc. violation or issues

  Media

• Violation:

Vehicle Information

• Vehicle Number:

• Vehicle Type:

• Year:

Vehicle Paperwork

• Is the insurance card in the vehicle?

  Yes

  No

  N/A

• Is the insurance still valid?

  Yes

  No

• Is the registration in the vehicle?

  Yes

  No

  N/A

• Is the registration still valid?

  Yes

  No

• Is the Inspection still valid for this vehicle?

  Yes

  No

• Is the truck height posted in the cab?

  Yes

  No

Vehicle Interior

• Is the hand railing secure along the entrance stairs?

  Safe

  At Risk

  N/A

• Are all of the windows and mirrors free of cracks, and in a safe condition?

  Yes

  No

• Is the drivers seat in a safe working condition?

  Yes

  No

• Is the drivers seat belt in a torn free, and safe working condition?

  Yes

  No

• Is the jumper seat in a safe working condition (does it retract automatically when not in use)?

  Yes

  No

• Is the jumper seat belt in a torn free, safe working condition?

  Yes

  No

• Is the cab of the truck clean overall, free of any clutter, and has no loose items on the dash?

  Good

  Fair

  Poor

• Fire extinguisher- tagged/charged/inspected/accessible?

  Okay

  Improper Charge

  Missing Inspection Tag

  Missing Pull Pin Tag

  Blocked/Missing

• Does the horn work (create an acceptable audible noise)?

  Yes

  No

• Is a First Aid Kit located in the vehicle?

  Yes

  No

• Is it expired?

  No

  Yes

• Are there any obstructions near or under pedals (including mats, loose trash, or bottles)?

  Safe

  At Risk

  N/A

• Is the rubber grip still on the pedals?

  Yes

  No

• Is the trash emptied weekly or not overflowing out of the can?

  Yes

  No

• Is the GPS unit plugged in and working?

  Yes

  No

  N/A

• Does the back up camera work?

  Yes

  No

  N/A

• Do both the right and left turn signals work?

  Yes

  No

• Is the dog house latched down and secure?

  Yes

  No

• Are the triangles and safety vest present in case of an emergency?

  Yes

  No

  N/A

• Is the roofing attached to support poles (translucent roofs only)

  Yes

  No

  N/A

Vehicle Exterior

• Is the front driver tire flat, bald, or have any concerning damage don't to it?

  No

  Yes

• Is the rear driver tire flat, bald, or have any concerning damage don't to it?

  No

  Yes

• Is the rear passenger tire flat, bald, or have any concerning damage don't to it?

  No

  Yes

• Is the front passenger tire flat, bald, or have any concerning damage don't to it?

  No

  Yes

• Are the plate lights working and in good condition?

  Yes

  No

• Are both of the license plates clean and legible? (free of any obstructions)

  Yes

  No

• Any damage concerns or major issues with the appearance of the truck?

  No

  Yes

• Are the front headlights in good condition?

  Yes

  No

• Are the tail lights in good condition?

  Yes

  No

Misc. Concerns

• Misc. violation or issues

  Media

• Violation:

Vehicle Information

• Vehicle Number:

• Vehicle Type:

• Year:

Vehicle Paperwork

• Is the insurance card in the vehicle?

  Yes

  No

  N/A

• Is the insurance still valid?

  Yes

  No

  N/A

• Is the registration in the vehicle?

  Yes

  No

  N/A

• Is the registration still valid?

  Yes

  No

  N/A

• Is the Inspection still valid for this vehicle?

  Yes

  No

  N/A

• Is the truck height posted in the cab?

  Yes

  No

  N/A

Vehicle Interior

• Is the hand railing secure along the entrance stairs?

  Safe

  At Risk

  N/A

• Are all of the windows and mirrors free of cracks, and in a safe condition?

  Yes

  No

• Is the drivers seat in a safe working condition?

  Yes

  No

• Is the drivers seat belt in a torn free, and safe working condition?

  Yes

  No

• Is the jumper seat in a safe working condition (does it retract automatically when not in use)?

  Yes

  No

• Is the jumper seat belt in a torn free, safe working condition?

  Yes

  No

• Fire extinguisher- tagged/charged/inspected/accessible?

  Okay

  Improper Charge

  Missing Inspection Tag

  Missing Pull Pin Tag

  Blocked/Missing

• Is the cab of the truck clean overall, free of any clutter, and has no loose items on the dash?

  Good

  Fair

  Poor

• Does the horn work (create an acceptable audible noise)?

  Yes

  No

• Is a First Aid Kit located in the vehicle?

  Yes

  No

• Is it expired?

  No

  Yes

• Are there any obstructions near or under pedals (including mats, loose trash, or bottles)?

  Safe

  At Risk

  N/A

• Is the rubber grip still on the pedals?

  Yes

  No

• Is the trash emptied weekly or not overflowing out of the can?

  Yes

  No

• Is the GPS unit plugged in and working?

  Yes

  No

  N/A

• Does the back up camera work?

  Yes

  No

  N/A

• Do both the right and left turn signals work?

  Yes

  No

• Do the gauges all reflect a safe zone in a normal range?

  Yes

  No

  N/A

• Is the dog house latched down and secure?

  Yes

  No

• Are the triangles and safety vest present in case of an emergency?

  Yes

  No

  N/A

Vehicle Exterior

• Is the front driver tire flat, bald, or have any concerning damage don't to it?

  No

  Yes

• Is the rear driver tire flat, bald, or have any concerning damage don't to it?

  No

  Yes

• Is the rear passenger tire flat, bald, or have any concerning damage don't to it?

  No

  Yes

• Is the front passenger tire flat, bald, or have any concerning damage don't to it?

  No

  Yes

• Are the plate lights working and in good condition?

  Yes

  No

• Are both of the license plates clean and legible? (free of any obstructions)

  Yes

  No

• Any damage concerns or major issues with the appearance of the truck?

  No

  Yes

• Are the front headlights in good condition?

  Yes

  No

• Are the tail lights in good condition?

  Yes

  No

Misc. Concerns

• Misc. violation or issues

  Media

• Violation:

Vehicle Information

• Vehicle Number:

• Vehicle Type:

• Year:

Vehicle Paperwork

• Is the insurance card in the vehicle?

  Yes

  No

  N/A

• Is the insurance still valid?

  Yes

  No

  N/A

• Is the registration in the vehicle?

  Yes

  No

  N/A

• Is the registration still valid?

  Yes

  No

  N/A

• Is the Inspection still valid for this vehicle?

  Yes

  No

  N/A

• Is the truck height posted in the cab?

  Yes

  No

  N/A

Vehicle Interior

• Is the hand railing secure along the entrance stairs?

  Safe

  At Risk

  N/A

• Are all of the windows and mirrors free of cracks, and in a safe condition?

  Yes

  No

• Is the drivers seat in a safe working condition?

  Yes

  No

• Is the drivers seat belt in a torn free, and safe working condition?

  Yes

  No

• Is the jumper seat in a safe working condition (does it retract automatically when not in use)?

  Yes

  No

• Is the jumper seat belt in a torn free, safe working condition?

  Yes

  No

• Fire Extinguisher (Under jumper seat or behind drivers seat)

  Okay

  Improper Charge

  Missing Inspection Tag

  Missing Pull Pin Tag

  Blocked/Missing

• Is the cab of the truck clean overall, free of any clutter, and has no loose items on the dash?

  Good

  Fair

  Poor

• Does the horn work (create an acceptable audible noise)?

  Yes

  No

• Is a First Aid Kit located in the vehicle?

  Yes

  No

• Is it expired?

  No

  Yes

• Are there any obstructions near or under pedals (including mats, loose trash, or bottles)?

  Safe

  At Risk

  N/A

• Is the rubber grip still on the pedals?

  Yes

  No

• Is the trash emptied weekly or not overflowing out of the can?

  Yes

  No

• Is the GPS unit plugged in and working?

  Yes

  No

  N/A

• Does the back up camera work?

  Yes

  No

  N/A

• Do both the right and left turn signals work?

  Yes

  No

• Do the gauges all reflect a safe zone in a normal range?

  Yes

  No

  N/A

• Is the dog house latched down and secure?

  Yes

  No

• Are the triangles and safety vest present in case of an emergency?

  Yes

  No

  N/A

Vehicle Exterior

• Is the front driver tire flat, bald, or have any concerning damage don't to it?

  No

  Yes

• Is the rear driver tire flat, bald, or have any concerning damage don't to it?

  No

  Yes

• Is the rear passenger tire flat, bald, or have any concerning damage don't to it?

  No

  Yes

• Is the front passenger tire flat, bald, or have any concerning damage don't to it?

  No

  Yes

• Are the plate lights working and in good condition?

  Yes

  No

• Are both of the license plates clean and legible? (free of any obstructions)

  Yes

  No

• Any damage concerns or major issues with the appearance of the truck?

  No

  Yes

• Are the front headlights in good condition?

  Yes

  No

• Are the tail lights in good condition?

  Yes

  No

Misc. Concerns

• Misc. violation or issues

  Media

• Violation:

• All exits free of obstructions?

  Yes

  No

  N/A

• Walkways clear?

  Yes

  No

  N/A

• Broken glass or metal objects

  No

  Yes

• Cylinder Tank Storage Container Shut and Free of any Damage?

  Yes

  No

• Misc. violation or issues

  Media

• Violation:

• Audit Completed By?

  Sign