• Planned Workplace Inspection

  • Document No.

  • Select date

  • Prepared by

  • Location
  • Inspected by:


  • Is all required training completed<br>?

  • Have risk assessments / FLRAs been completed, reviewed and signed off by leader/supervisor?

  • Other


  • Is eye protection (sealed, goggle, faceshield, etc.)<br>- Worn when/where required?<br>- In good condition, no damage?

  • Is foot protection (metatarsal guards):<br>- Worn when/where required?<br>- In good condition?<br>- Slip guards used where appropriate?

  • Is hand protection (proper glove for the job):<br>- Worn when/where required?<br>- In good condition?

  • Is hearing protection (plugs, muffs, both):<br>- Worn when/where required?<br>- In good condition?

  • Is respiratory protection (1/2 face, full face, PAPR, Air-Supplied):<br>- Worn when/where required?<br>- Appropriate use of filters/cartridges for the contaminant(s) present?<br>- Apparatus and filters/cartridges in good condition?

  • Is fall protection (Harness, SRL, Lanyards, etc.):<br>- Worn when/where required and properly fitted?<br>- In good condition?<br>- Pre-Use inspection completed?<br>- Certified and correct harness used for the application? (fall arrest, evacuation/retrieval etc.)

  • Other

General Facility/Site Conditions/Housekeeping

  • Are surface/floor/wall/ceilings:<br>- In good condition, free of hazards?

  • Are exits/egress routes clear and signage posted?

  • Are stairways/walkways/ramps/platforms:<br>- clear and free of hazards

  • Are driveways / aisles:<br>- Unobstructed, have good visibility and clear of hazards?

  • Are there sufficient warning signs/markings/postings and do they clearly identify the hazards that may be present?

  • Is general and emergency lighting/alarms in good working order and inspected regularly?

  • Are handrails secure and free of excessive defects?<br> -Heavily damaged handrails that require replacement? Loose? Broken welds? Bent handrails and/or toe boards?<br> -Handrails do not contain excessive oil/grease?

  • Other

Tools, Equipment and Rigging

  • Are hand-power tools free of defects?<br>- Damaged/broken equipment tagged and taken out of service?

  • Are air guns & hoses pinned / are valves in good condition?

  • Are Slings, Chains, Rigging Inspected & Tagged?

  • Are horses/cribbing in good condition and stored properly when not in use?

  • Other

Orderliness & Material / Chemical Storage

  • Are materials stacked securely and storage organized and free of clutter?<br>- Are stored materials easily and safely accessible?

  • Are there adequate containers provided for debris and is proper waste disposal in practice?

  • Is there effective spill containment & response / proper resources available?<br>- Spill kit visible and accessible?

  • Are proper container in use - and properly labeled?

  • Are MSDS/SDS available/ reviewed?

  • Other

Emergency Response/Fire Protection

  • Are Fire extinguishers available, inspected monthly and unblocked?

  • Are Employees aware of emergency procedures and where assembly areas are? (Interview >=2 employees)

  • Are Eyewash/Safety Shower stations inspected and unblocked?

  • Is there sufficient emergency equipment installed in the area?<br> -Fire extinguishers, eyewash, safety shower, spill kits, alarm pull stations, etc.

  • Are fire suppression systems unblocked and free of damage?

  • Is signage - No Smoking, Flammable, Combustible Signs installed, visible and in good condition?

  • Is Emergency Contact Information current?<br>- updated contact list posted?<br>- evacuation route updated and posted?

  • Are Flammables/Combustible Liquids / Material Storage<br>- Properly labeled and stored?

  • Are there Welding & Cutting (Flash Arrestors) available and being used? (interview employees)

  • Are Oxy - Fuel Cylinders Stored 25' apart?

  • Are Hot Work Permits / Emergency Controls in place where required?

  • Other

Mobile Equipment

  • Is equipment inspected as per frequency requirements?<br>- Inspection booklet on equipment and completed to date

  • Are operators using horns and warning devices where required?

  • Are spotters used when there is limited visibility?<br>( Interview equipment operators/area supervisor if available)

Electrical Hazards/Arc Flash

  • Are High voltage signs in place and visible?

  • Are Electrical cabinets closed and in good repair?<br> -Do the cabinets close securely?

  • Are Electrical cabinets unblocked?<br> -Nothing within 36 inches of the front of the cabinet?<br> -Clear access/pathway to electrical cabinets?

  • Is Arc flash signage in place?<br> -Indicates arc flash category?

  • Is Proper arc flash PPE available and in use?

  • Are GFCI in place and being used?

  • Are Cords, Tools, Plugs Inspected and Color-Coded?

  • Generators and Welders Grounded

Lockout Tagout - Energy Control

  • Are employees expected to conduct lockout trained and equipped properly?<br> -Employees understand their role and requirements?<br> -Employees have locks available if needed?

  • Are employees locked out during a change over and/or other tasks that require lockout?<br> -All employees who are working on the equipment have their own lock affixed to the proper energy source(s)?<br> -Lockout was verified, stored energy was dissipated and equipment will not operate?

  • Are energy control procedures exist for all equipment in the area and employees know where to find them?

  • Have lockout exceptions been adequately evaluated and determined safe?<br> -Do regular tool/machine adjustments introduce hazards with unacceptable risk?<br> -Other exceptions?

Equipment - Crane/Hoists, Loaders, Forklifts, Aerial Lifts & All Other Machines

  • Are pre-use inspections completed as per requirements?<br>- Inspections signed off by leader/supervisor?<br>- Completed Daily?

  • Are employees working under suspended loads?

  • Are cranes working within their operating limits?<br> -Capacity not exceeded?<br> -Upper limit switch not used as a stop?

  • Are Alarms, Horns and Warning Lights Working?

  • Are all Equipment Guards in Place / Wheel Chocks available and in use?

  • Is operating condition safe overall?<br>

  • Other

Fall Protection

  • Is the underfoot walking working surface safe?<br>

  • Are handrail systems / perimeter guards installed and in good condition?

  • Is scaffolding properly installed, inspected and tagged?

  • Is the ladder in good condition? Setup correctly? Tied Off & Use?

  • Are personnel practicing 100% tie off as required?

  • Are wall openings guarded and holes covered?

Signature and Finalization

  • I have completed this assessment to the best of my knowledge. This audit is not intended to identify all safety and health hazards, but to identify all visible/known hazards as of the date printed on the completed assessment. assessment.

  • Select date

  • General Comments

  • Overall Safety Score

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.