Entergy Facility Monthly Safety Inspection Form

• Service Center

• Conducted on

  Date

• Prepared by

• Location
  Address

• Are Overhead Lights in Good Working Condition?

  Yes

  No

  N/A

• Do Ceiling Tiles Have Leaks Or Bulges?

  Yes

  No

  N/A

• Is There Visible Signs of Mold or Mildew?

  Yes

  No

  N/A

• Are Aisles And Stairways Are Clean, Orderly and Unobstructed? 29 CFR 1910.22

  Yes

  No

  N/A

• Are Floors And Work Areas Are Free From Spills and buckled flooring; Walkways Clearly Marked and Unobstructed? 29 CFR 1910.22

  Yes

  No

  N/A

• Are Automatic Door Closure Devices Are Securely Mounted And Working Properly?

  Yes

  No

  N/A

• Are Door Knobs and Locks in Proper Working Order?

  Yes

  No

  N/A

• Are All Mats/Rugs are Free from Tripping and/or Slipping Hazards?

  Yes

  No

  N/A

• Are All Exit Doors Are Properly Marked With “EXIT” Signs? 29 CFR 1910.37(b)(2)

  Yes

  No

  N/A

• Are all Emergency / Exit Lighting Operable (Bulbs) (Push Test Button)? 29 CFR 1910.37(b)(1)

  Yes

  No

  N/A

• Are All Exit Routes Clear? 29 CFR 1910.37

  Yes

  No

  N/A

• Are Emergency Evacuation Routes Posted and Up to Date? 29 CFR 1910.38

  Yes

  No

  N/A

• Is The Safe Room/Shelter Area Marked and Signs Posted? 29 CFR 1910.38

  Yes

  No

  N/A

• Is There a Sign-In Book At All Entries?

  Yes

  No

  N/A

• Are the Restrooms Are Clean, Supplied And Functional? 29 CFR 1910.141

  Yes

  No

  N/A

• Are Waste Containers Are Emptied Regularly? 29 CFR 1910.22 General; 29 CFR1910.141 Food

  Yes

  No

  N/A

• Are Fire, Medical, Police Posted & On Every Phone? 29 CFR 1910.151

  Yes

  No

  N/A

• Does The Air Horn Have Any Signs Of Damage, Rust, Leaks, Cracks Or Any Signs Of Tampering? 29 CFR 1910.38

  Yes

  No

  N/A

• Does AED Cabinet Alarm work?

  Yes

  No

  N/A

• Are The AED Pads Expired?

  Yes

  No

  N/A

• What Is The Date On The Expired Pads?

  Date

• Is The AED Battery Expired?

  Yes

  No

  N/A

• What Is the Date On The Expired Battery?

  Date

• Is the FAK Full Of All Required Contents? 29 CFR 1910.151

  Yes

  No

  N/A

• What Contents Are Missing?

  Select Bio-Bag Towels And Wipes Body Fluid Cleanup Absorbent Face Mask With Eye Shield Gown Nitrile Gloves CPR Face Shield 1"X3" Adhesive Bandages Sterile Triangle Bandage Hema-Flex Bandage Compress Knuckle And Fingertip Bandages 4" Hema-Flex Bandage Compress Burn Gel Packs 4"X4" Burn Dressing Eye Wash Sting Relief Swabs Povidone Iodine Antiseptic Wipes Scissors And Tweezers

  • Bio-Bag Towels And Wipes
  • Body Fluid Cleanup Absorbent
  • Face Mask With Eye Shield
  • Gown
  • Nitrile Gloves
  • CPR Face Shield
  • 1"X3" Adhesive Bandages
  • Sterile Triangle Bandage
  • Hema-Flex Bandage Compress
  • Knuckle And Fingertip Bandages
  • 4" Hema-Flex Bandage Compress
  • Burn Gel Packs
  • 4"X4" Burn Dressing
  • Eye Wash
  • Sting Relief Swabs
  • Povidone Iodine Antiseptic Wipes
  • Scissors And Tweezers

• What Is The Number Of The Incomplete FAK? If It Does Not Have A Number, Please Assign It One.

• Does The FAK Contain Any Expired Contents? 29 CFR 1910.151

  Yes

  No

  N/A

• What Contents Are Expired?

  Select Burn Gel Packs 4"X4" Burn Dressing Eye Wash Povidone Iodine Antiseptic Wipes Sting Relief Swabs

  • Burn Gel Packs
  • 4"X4" Burn Dressing
  • Eye Wash
  • Povidone Iodine Antiseptic Wipes
  • Sting Relief Swabs

• What Is The Number Of The FAK With Expired Contents? If It Does Not Have A Number, Please Assign It One.

• Is The Bloodborne/Sharps Waste Disposal Kit Intact? 29 CFR 1910.1030

  Yes

  No

  N/A

• Where Is This Kit Located?

• Is The Bloodborne/Sharps Waste Disposal Kit Overflowing And Need To Be Emptied? 29 CFR 1910.1030

  Yes

  No

  N/A

• Where Is This Kit Located?

• Are All Electrical Cords Covered In Conference & Meeting Rooms, And Secured Under All Desks & Work Stations? 29 CFR 1910.305

  Yes

  No

  N/A

• Do All GFCI Receptacles Work? (Test By Pushing The Test Button)

  Yes

  No

  N/A

• Where Is The GFCI Receptacles That do not work?

• Are Electrical Panels And Breakers Properly Marked? 29 CFR1910.303 (f); 1910.303 (b)

  Yes

  No

  N/A

• Where Is The Unlabeled Panel or Panels Located?

• Is The Safety Information Board Up-to-Date? (Alerts, SAB Minutes, Domiciled Employee list, etc...)

  Yes

  No

  N/A

• Is The Most Current OSHA Posters On The Safety Information Board? 29 CFR 1903.2

  Yes

  No

  N/A

• Is The Safety Data Sheet (SDS) Binder Readily Accessible And Up To Date? 29 CFR 1910.1200

  Yes

  No

  N/A

• Are Storage Areas Free From Materials That Could Cause Tripping? 29 CFR 1910.176(c)

  Yes

  No

  N/A

• Are Materials Properly Stored On Cabinet Tops, Shelves & Bookcases? (Do Not Double Stack Materials On The Top Shelf and Do No Block Sprinklers) 29 CFR 1910.176(b); 29 CFR 1910.159(c)(10)

  Yes

  No

  N/A

• Are Ladders Inspected and Tagged Monthly? 29 CFR 1926.1053(b)(15); 29 CFR 1926.1053(b)(16)

  Yes

  No

  N/A

• Where Are These Ladders Located?

• Are Paper Cutter Blades, Shears, Scissors And Pencils Kept/Stored In Down Position in Protective Container When Not In Use?

  Yes

  No

  N/A

• Are Fire Extinguishers Tagged With Annual Maintenance Date & Monthly Visual Checks? 29 CFR 1910.157

  Yes

  No

  N/A

• What Is The Date On The Expired Fire Extinguisher?

  Date

• What Are The Numbers Of The Expired Fire Extinguishers? If The Fire Extinguisher Does Not Have A Number, Please Assign It One.

• Are There Any Other Concerns Not Listed Above?

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• Yes

  No

  N/A

• Are Chemicals Properly Labeled And Stored? 29 CFR 1910.1200

  Yes

  No

  N/A

• Is Personal Protective Equipment Available For All Chemical Products Listed On the Site Inventory?

  Yes

  No

  N/A

• Are Flammables Properly Stored? 29 CFR 1910.106

  Yes

  No

  N/A

• Are Gas Cylinders (Empty or Full) Properly Separated, Stored and Marked? 29 CFR 1910.252; 29 CFR 1910.110

  Yes

  No

  N/A

• Are Ladders Inspected and Tagged Monthly? 29 CFR 1926.1053(b)(15); 29 CFR 1926.1053(b)(16)

  Yes

  No

  N/A

• Where Are These Ladders Located?

• Is The Electric Forklift Recharging Areas Marked? 29 CFR 1910.178(g)(1)

  Yes

  No

  N/A

• Is There An Acid Neutralizing Agent Near the Designated Charging area?

  Yes

  No

  N/A

• Is There An Eye Wash Station Near The Designated Charging Area?

  Yes

  No

  N/A

• Forklift Mast Height Clearly Labeled 29 CFR 1910.178(a)(6)

  Yes

  No

  N/A

• Are Overhead Door Heights Labeled? 1910.176(e)

  Yes

  No

  N/A

• Where Are These Doors Located?

• Are All Overhead Doors Properly Maintained And In Good Condition?

  Yes

  No

  N/A

• Where Are The Doors That Need Repaired Located?

• Are All Automatic Door Closure Devices Securely Mounted?

  Yes

  No

  N/A

• Where Is The Automatic Door Closer Device That Needs Repaired Located?

• Is All Overhead Lighting Properly Working?

  Yes

  No

  N/A

• Are Door Knobs And Locks In Proper Working Order?

  Yes

  No

  N/A

• Where Are The Door Knobs And Locks That Need Repaired Located?

• Are All Mats/Rugs Free From Tripping And/Or Slipping Hazards?

  Yes

  No

  N/A

• Where Are The Mats/Rugs That Need Attention Located?

• Are Emergency / Exit Lighting Operable (Bulbs) (Push Test Button)? 29 CFR 1910.37(b)(1)

  Yes

  No

  N/A

• Where Are The Emergency/Exit Lights That Need Repaired Located?

• Are Storage Areas Free From Accumulation Of Materials That Constitute Hazards From Tripping, Fire, Explosion Or Harboring Pests?

  Yes

  No

  N/A

• Are Shelves Secured From Falling Over?

  Yes

  No

  N/A

• Where Are The Shelves That Need Secured Located?

• Is The Weight Ratings Marked On Shelves?

  Yes

  No

  N/A

• Where Are The Shelves That Need A Weight Rating Label Located?

• Are Walking Aisles Marked On Floors.?

  Yes

  No

  N/A

• Do Aisles Have Material Stacked In them?

  Yes

  No

  N/A

• Is There Material Sticking Out Of Bins/shelves?

  Yes

  No

  N/A

• Are Defective Tools Tagged And Removed From Use? 29 CFR 1910.242

  Yes

  No

  N/A

• Where Are The Defective Tools Located?

• Are Electrical Powered Hand Tool Cords In Good Condition? 29 CFR 1910.303

  Yes

  No

  N/A

• Where Are Electrical Powered Hand Tools That Need Repairs Located?

• Are Portable Power Tools In Good Condition And Properly Stored? 29 CFR 1910.303

  Yes

  No

  N/A

• Are Gasoline Powered Equipment (Saws, etc.) Properly Stored?

  Yes

  No

  N/A

• Are Hand Tools Properly Stored?

  Yes

  No

  N/A

• Are Extension Cords And Electrical Cords In Good Condition? 29 CFR 1910.305

  Yes

  No

  N/A

• Do Grinders Have Proper Spacing On Work Rest? 29 CFR 1910.215(a)(4)

  Yes

  No

  N/A

• Are Goggles Or Face Shields Available At Grinder Location? 29 CFR 1926.102

  Yes

  No

  N/A

• Are Slings Marked And In Good Condition? 29 CFR 1910.184(c)

  Yes

  No

  N/A

• Do All GFCI Receptacles Work? (Test By Pushing The Test Button)

  Yes

  No

  N/A

• Where Are The GFCI Receptacles That do not work?

• Are There Visible Signs of Mold or Mildew?

  Yes

  No

  N/A

• Is The Eye Wash Station Operable And Free Of Debris?

  Yes

  No

  N/A

• Is the FAK Full Of All Required Contents? 29 CFR 1910.151

  Yes

  No

  N/A

• What Contents Are Missing?

  Select Bio-Bag Towels And Wipes Body Fluid Cleanup Absorbent Face Mask With Eye Shield Gown Nitrile Gloves CPR Face Shield 1"X3" Adhesive Bandages Sterile Triangle Bandage Hema-Flex Bandage Compress Knuckle And Fingertip Bandages 4" Hema-Flex Bandage Compress Burn Gel Packs 4"X4" Burn Dressing Eye Wash Sting Relief Swabs Povidone Iodine Antiseptic Wipes Scissors And Tweezers

  • Bio-Bag Towels And Wipes
  • Body Fluid Cleanup Absorbent
  • Face Mask With Eye Shield
  • Gown
  • Nitrile Gloves
  • CPR Face Shield
  • 1"X3" Adhesive Bandages
  • Sterile Triangle Bandage
  • Hema-Flex Bandage Compress
  • Knuckle And Fingertip Bandages
  • 4" Hema-Flex Bandage Compress
  • Burn Gel Packs
  • 4"X4" Burn Dressing
  • Eye Wash
  • Sting Relief Swabs
  • Povidone Iodine Antiseptic Wipes
  • Scissors And Tweezers

• What Is The Number Of The Incomplete FAK? If It Does Not Have A Number, Please Assign It One.

• Does The FAK Contain Any Expired Contents? 29 CFR 1910.151

  Yes

  No

  N/A

• What Contents Are Expired?

  Select Burn Gel Packs 4"X4" Burn Dressing Eye Wash Povidone Iodine Antiseptic Wipes Sting Relief Swabs

  • Burn Gel Packs
  • 4"X4" Burn Dressing
  • Eye Wash
  • Povidone Iodine Antiseptic Wipes
  • Sting Relief Swabs

• What Is The Number Of The FAK With Expired Contents? If It Does Not Have A Number, Please Assign It One.

• Are The Fire Extinguishers Properly Separated and Labeled Empty/Full?

  Yes

  No

  N/A

• Are Fire Extinguishers Tagged With Annual Maintenance Date & Monthly Visual Checks? 29 CFR 1910.157

  Yes

  No

  N/A

• What Is The Date On The Expired Fire Extinguisher?

  Date

• What Are The Numbers Of The Expired Fire Extinguishers? If The Fire Extinguisher Does Not Have A Number, Please Assign It One.

• Are There Any Other Concerns Not Listed Above?

• Is The Yard Fencing Intact And Gates Secured?

  Yes

  No

  N/A

• Are Dock Steps / Stairways / Grab Bars are Securely Attached?

  Yes

  No

  N/A

• Are All Steps In Good Condition?

  Yes

  No

  N/A

• Are Vehicles Properly Parked?

  Yes

  No

  N/A

• How Is The Yard Housekeeping?

  Good

  Fair

  Poor

  N/A

• Are The Chemical Products Properly Stored?

  Yes

  No

  N/A

• Are Material Bins And Scrap Bins Free Of Overhanging Obstructions? 29 CFR 1910.176(c)

  Yes

  No

  N/A

• Are Materials Properly Stored And Separated? 29 CFR 1910.176(c)

  Yes

  No

  N/A

• Is The Pole Pile Free Of Stacking And Rolling Hazards? 29 CFR 1910.176(b)

  Yes

  No

  N/A

• Has Wire Been Removed From Returned Materials/Transformers?

  Yes

  No

  N/A

• Are Forklifts And Cranes Properly Equipped And Maintained? Daily Inspections attached? 29 CFR 1910.178(p) Forklifts; 29 CFR 1910.179-181 Cranes

  Yes

  No

  N/A

• Do All Trailers Have Their Wheels Chocked?

  Yes

  No

  N/A

• Do All GFCI Receptacles Work? (Test By Pushing The Test Button)

  Yes

  No

  N/A

• Where Are The GFCI Receptacles That do not work?

• Are There Any Other Concerns Not Listed Above?

• By signing below I acknowledge that this inspection was completed to the best of my knowledge and abilities.

  Sign