• Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Work area observation

  • Uniform: appearance, USafe logo

  • Posters: Usafe

  • Equipment: Electrical powered tools

Walking & working surfaces

  • Floor care: wet floor signs in use

  • Ladders: proper set-up and usage

  • Proper footwear for job task

  • Slips, Trips & Fall hazards

  • Disposal area: compactors, dumpsters, etc.

  • Sanitary Drainage Availability - Slop sinks, floor drains

  • Eye wash/Showers: Battery charging, corrosive chemical exposure (stripping solution)

Personal Protective Equipment

  • Eye/face protection: safety glasses, goggles, face shield

  • Hand protection: Disposable gloves, Chemical resistant gloves, winterized gloves

  • Foot protection: slip resistant shoes, company supplied boots when stripping floors, stableicers for winter wear

  • Dust masks when required: Sweeping, dusting, raking

  • Body protection: when working with acids, chemicals, battery charging, etc.

  • Fall protection: when falls of 6' or greater, aerial lifts

  • Knee pads: when necessary

  • Other required PPE

Body Mechanics and Ergonomics

  • Lifting/Carrying/Pulling/Pushing: Body movement

  • Trash removal: from baskets, barrels, drums, carts

  • Disposal of waste: to compactor and/or dumpster

  • Restroom cleaning: toilets, mirrors, ect.

Tools and equipment

  • Selection: Proper tool or equipment for job

  • Condition: Tools and equipment in safe conditions for use

  • Use: Tool and equipment being used as intented

  • Mobile equipment: Inspected prior to use, safe ops.

Hazard communication/ chemicals

  • Hazard Communication Written Program

  • Chemical inventory list, Material Safety Data Sheet (MSDS)

  • Proper labeling of containers

  • Compatibility storage - acid/base

  • Flammable storage cabinets


  • Is any follow up required?<br><br>

  • Add media

Commendable behaviors observed:

  • Add media

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.