Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location
  • 01 Mar 2022 / Victor Murillo

  • Score

  • Failed items

  • Actions

  • Which Building are you inspecting?

  • Which department / area are you inspecting?

  • Conducted on

  • Document No

  • Prepared by : Enter your name

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  • Complete

  • 1 Mar 2022 13:17 PST

  • Victor Murillo

  • Victor Murillo 000003

  • Private & Confidential

Failed Items

Walking / Working Surfaces / Stairs / LADDERS / SCAFFOLDING

  • Are all ladders inspected and in good condition with no structural damage?

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  • 4 failed

  • Photo 1

  • Photo 2

  • Photo 3

Walking / Working Surfaces / Stairs / LADDERS / SCAFFOLDING

  • Are there no metal or aluminum ladders in electrical areas?

Crane / Hoist / Lifting Devices

  • Do air nozzles have relief valves to decrease pressure to 29 psi or lower?

  • Photo 4

Equipment

  • Photo 5

  • Private & Confidential

Aisles / Exits / Egress

AISLES/EXITS/EGRESS

  • Are Aisles/ Exits / Egresses to be inspected in this audit?

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  • Private & Confidential

Walking / Working Surfaces / Stairs

WALKING / WORKING SURFACES / STAIRS

  • Are walking / working surfaces / stairs to be inspected in this audit?

LADDERS / SCAFFOLDING

  • Are Ladders / Scaffolding to be inspected in this audit?

  • Are all step ladders under 20 feet in length?

  • Are rubber feet on ladders in good repair?

  • Are all ladders inspected and in good condition with no structural damage?

  • Photo 1

  • Photo 2

  • Photo 3

  • Are there no metal or aluminum ladders in electrical areas?

  • Are ladders being used properly (only one person on ladder at a time and no one standing above the second step down from the top)?

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  • 2 failed, 50%

  • 2 failed, 60%

  • Private & Confidential

Electrical Grounding

ELECTRICAL GROUNDING

  • Is Electrical Grounding to be inspected in this audit?

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  • Private & Confidential

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Personal Protective Equipment (PPE)

PERSONAL PROTECTIVE EQUIPMENT (PPE):

  • EYE/FACE, RESPIRATORY, HEARING

  • Is PPE to be inspected in this audit?

  • Private & Confidential

  • Fall Protection

FALL PROTECTION

  • Is Fall Protection to be inspected in this audit?

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  • Private & Confidential

Crane / Hoist / Lifting Devices

CRANE / HOIST / LIFTING DEVICES

  • Are Crane / Hoist / Lifting Devices to be inspected in this audit?

  • Photo 4

  • Does the operator have a full, unrestricted view before lifting load?

  • Are all loads being lifted overhead secured?

  • Is there no one beneath the load while it is suspended?

  • Does the crane operator have a current license or certificate?

  • Is the move checklist being used for Critical Lifts?

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  • 1 failed, 83.33%

  • Private & Confidential

Equipment

EQUIPMENT

  • Is Equipment to be inspected in this audit?

  • Grinding wheel surface not damaged or worn (must be square and no grinding on side of wheel)

  • No aluminum found in grinding wheel surface?

  • Are fans inspected annually for damage (cracked blades, guards, cords, etc)?

  • Are heat lamps and work light bulbs guarded?

  • Are all fixed machines bolted to the floor?

  • Do air nozzles have relief valves to decrease pressure to 29 psi or lower?

  • Photo 5

  • Are air disconnects and safety nozzles the correct type (safety relief vents may not be covered or sealed in any way)?

Machinery

  • Are you inspecting a specific piece of equipment?

  • Private & Confidential

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1 failed, 77.78%

Forklift / Powered Industrial Truck

FORKLIFT / POWERED INDUSTRIAL TRUCK

  • Are Forklifts / Powered Industrial Trucks to be inspected in this audit?

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  • Private & Confidential

Compressed Gas Cylinders

COMPRESSED GAS CYLINDERS

  • Are you inspecting Compressed Gas Cylinders?

  • Are cylinders legibly marked to clearly identify the gas contained?

  • Are valve protector caps placed on cylinders when not in use?

  • Are flammables and combustibles stored properly?

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  • Private & Confidential

Ergonomics

ERGONOMICS

  • Are you inspecting ergonomics?

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  • Private & Confidential

Emergency, Health, & Safety Information

EMERGENCY, HEALTH & SAFETY INFORMATION

  • Are Emergency. Health & Safety information to be inspected in this audit?

  • Are fire alarm "Air Horn" locations marked and unobstructed?

  • Are sign for emergency numbers, routes, and evacuation routes posted?

  • Are the Emergency Response Team Members (ERT) assigned?

  • Do employees know who their ERT Members are?

  • Name of ERT Member for this work area

  • Does the ERT Member have their numbers readily available, functional?

  • Are employees trained on emergency procedures (primary and secondary routes)? Do they know where to go?

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  • Private & Confidential

Hazardous Communication - Chemical Safety

HAZARD COMMUNICATION - CHEMICAL SAFETY

  • Is Chemical Safety to be inspected in this audit?

  • Are all chemical containers not in use closed with lids?

  • Are all chemicals removed from fume hoods and stored in proper cabinets?

  • Are all plating/chemical tanks not in use clean, dry, and covered?

  • Is grit blast cabinet area clean and garnet hopper emptied daily?

  • Is food separated and away from chemicals in the work area?

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  • Private & Confidential

Satellite Waste Accumulation - B2

SATELLITE WASTE ACCUMULATION - B2

  • Are you Inspecting Building 2 Satellite Accumulation?

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  • Private & Confidential

Satellite Waste Accumulation - B 3

HAZARDOUS WASTE - SATELLITE WASTE

  • ACCUMULATION

  • Are you Inspecting Building 3 Satellite Accumulation?

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  • Private & Confidential

Satellite Waste Accumulation - B4

HAZARDOUS WASTE - SATELLITE WASTE

ACCUMULATION - PLATING

  • Are you inspecting B4 Satellite Waste Accumulation?

  • Are you inspecting Ceramics ?

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  • Private & Confidential

Satellite Waste Accumulation - B7

SATELLITE WASTE ACCUMULATION - B 7

  • Are you Inspecting Building 7 Satellite Accumulation?

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  • Private & Confidential

  • Appendix

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  • Photo 1

  • Photo 2

  • Photo 3

  • Photo 4

  • Private & Confidential

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  • Photo 5

  • Private

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.