Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
Chemicals/Flammables
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Are there any flammable cabinets at this location?
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Is the cabinet door self-closing?
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Are there only flammable liquids stored within the cabinets (no other liquids, tools, boxes, or PPE)?
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Are flammable liquids in approved containers?
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Are all containers closed?
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Are there less than 60 gallons of flammable liquids in the cabinet?
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Are chemicals stored within a containment?
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Are there signs of current or past leakage within or around the containment?
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Are containers closed when not in use?
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Is there a spill response kit in the area?
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Does the spill kit contain PPE?
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Does the spill kit contain an adequate amount of absorbents to contain a spill?
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Are employees using chemicals at this location?
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Is proper PPE being worn when using chemicals?
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Are chemicals being left open and unattended?
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Are employees aware of flammable liquid storage requirements?
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Do employees know when to clean a spill themselves and when to report?
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Do employees know where to find a spill response kit?
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Do employees know how to obtain an SDS for the material?
Ergonomics
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Do employees perform high repetition tasks (100 reps/hr or 2000 reps/day)?
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Do the employee's routine tasks require repeated heavy lifting (>20 lbs) or occasional heavy lifting (>50 lbs)?
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Are they using proper lifting form and lifting safely?
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Are employees using awkwardly designed tools which cause them to operate the tool outside of a neutral position for an extended period of time?
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Do employees perform tasks with an awkward head or neck position for an extended period of time?
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Do employees perform tasks that require awkward back angles to be held for an extended period of time?
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Do employees perform tasks with an awkward elbow angle for an extended period of time or with extreme force application?
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Do employees perform tasks with an awkward wrist flexion angle for an extended period of time or with extreme force application?
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Do employees perform tasks with an awkward back/hip flexion angle for an extended period of time or with extreme force application?
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Do employees perform tasks with an extreme reaching distance for an extended period of time or with extreme force application?
Employee Questions
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Do you experience pain or soreness at the end of your shift?
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Where?
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If your job is causing you physical discomfort, who do you report it to? (Supervisor, Lead, or EHS are acceptable answers)
Machine Safety/Dress for Safety
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Are emergency stop buttons visible, distinguishable, and within reach of the operator(s)?
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Do the emergency stop buttons function correctly? (ask operator to demonstate)
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Are moving parts of the machine adequately guarded in order to prevent injury?
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Do safeguards insure that no objects will fall into the moving parts?
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Are interlocks functional? (ask operator to demonstrate)
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Are guards and interlocks firmly secured and not easily removable?
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Is there evidence that safeguards have been tampered with or removed?
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Is a conveyor present?
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Are in-running nip points labeled?
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Is the guard at the in-running nip point adequately spaced to minimize the chances of injury?
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Are operators working a safe distance away from the in-running nip point(s)?
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Are employees wearing their hair above their shoulders?
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Are employees wearing loose clothing or jewelry that could get caught in the machine?
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Are employees wearing firm shoes with slip resistant soles that cover the entire foot?
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Do employees have long fingernails (more than 1/4" past the fingertip?
Employee Questions
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Can the employee(s) demonstrate knowledge of the E-Stop locations on their machine?
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Does the employee understand the purpose of the E-Stop as well as the components it stops and doesn't stop?
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Is the employee aware of the locations and functions of guards and interlocks?
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Is the employee aware of the locations of in-running nip points and the hazards they pose?
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Is the employee aware of the PLI dress for safety requirements?
Mobile Equipment/Pedestrian Safety
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Are manual pallet jacks used in the area?
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Are manual pallet jacks stored safely when not in use?
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Are operators communicating with people both visually and verbally when using a pallet jack within 5 feet of them?
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Are the loads they are carrying safe and stable?
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Have all hazards been removed in the area of operation?
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Are powered pallet jacks being used in the area?
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Has the operator filled out an inspection form?
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Can the operator demonstrate the inspection process?
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Does the operator have their PLI mobile equipment permit on their person?
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Is the operator sounding their horn in congested areas and blind corners to alert pedestrians?
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Is the operator positioned to the front and side of the powered pallet jack while it is in operation?
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Is the operator using the powered pallet jack in an area that is too congested for safe operation?
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Is the operator communicating both visually and verbally with people within 5 feet of them?
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Is the load they are carrying safe and stable?
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Are there any forklifts in use in the area?
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Is the forklift parked safely (turned off, in neutral, forks on ground, brake engaged)?
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Has the operator filled out an inspection form?
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Can the operator demonstrate the inspection process?
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Does the operator have their PLI mobile equipment permit on their person?
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Is the operator sounding their horn in congested areas and blind corners to alert pedestrians?
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Is the operator carrying their load close to the ground and in a manner to avoid an obstructed view?
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Is the load safe and stable?
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Is the operator communicating both visually and verbally with people within 5 feet of them?
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Are pedestrians on alert, communicating both visually and verbally with operators within 5 feet of them?
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Are pedestrians aware of the five foot rule?
PPE/Knife Use
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Are there PPE requirements for operators in the area?
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Are employees properly wearing the PPE required for this area?
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If chemicals or compressed air are being used, are safety glasses being worn?
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Are safety glasses un-tinted, with sideshields, and in good condition?
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Are safety glasses being worn over prescription glasses when applicable?
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If gloves are required, are employees wearing the correct gloves to address the hazard(s)?
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Are knives used in this area?
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Are employees only using knives issued by PLI?
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Can the blade be left exposed when not in use?
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If metal-bladed knives are unguarded not automatically retracting, is a cut glove being used on the non-cutting hand?
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Would a safer knife be feasible for this task?
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Are employees using proper cutting techniques?
Employee Questions
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Are employees aware of the PPE requirements for their area?
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Do employees know when and how to get PPE?
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If employees use knives, do they know proper cutting techniques?
Housekeeping/Slip, Trip, and Fall
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Are floors clean and clear of waste?
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Are floors in good condition?
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Are personal items such as clothing and lunch boxes in assigned lockers or storage areas?
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Is the work area clear of hazards?
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Are aisles unobstructed and clearly and appropriately marked?
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Are aisles and walkways wide enough to accommodate workers and equipment?
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Is there an accumulation of waste in the work area?
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Are waste containers adequate in size and proximity to the areas where waste is produced?
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Are there any chemicals or rags in general waste containers?
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Is the waste emptied regularly?
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Is there clear access to fire extinguishers, first aid kits, and/or eyewash stations?
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Is there a 36" clearance in front of electrical panels?
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Are clearance zones in front of emergency equipment and electrical panels clearly marked?
Employee Questions
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Is the employee aware of the clearance zones for electrical and emergency equipment?
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Is the employee aware of what red/white and black/yellow tape signify?
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Is the employee aware of locations for disposal of chemicals and rags?