FACILITY INSPECTION FORM

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

Emergency Preparedness

• ☐ Exit doors are unblocked & unlocked

  Yes

  No

  N/A

• ☐ Exit signs are illuminated & directional signs are posted as needed

  Yes

  No

  N/A

• ☐ Fire extinguisher location is marked by sign or red-colored post & is unblocked for 3’, mounted with the handle 3.5’-5’ above the floor and Fire extinguisher is the ABC type, is charged & inspection tag marked as inspected monthly by a FR employee and annually by a vendor.

  Select Yes No N/A

  • Yes
  • No
  • N/A

• ☐ First Aid kits & Bodily Fluid clean-up kit is stocked.

  Yes

  No

  N/A

• ☐ Eyewash stations unblocked, clean & functional.

  Yes

  No

  N/A

• ☐ Emergency evacuation alarm system is operational.

  Yes

  No

  N/A

• ☐ Fire sprinkler system/risers inspected annually by a vendor and internally inspected every 5 years.

  Yes

  No

  N/A

• ☐ Fire sprinkler heads are protected from paint spray or other potential obstruction by a paper bag covering.

  Yes

  No

  N/A

• ☐ Evacuation maps are posted in common areas.

  Yes

  No

  N/A

Machinery/Equipment

• ☐ Machine guards & devices are in place & in good operating condition (ensure miter saw & radial arm saw guards extend & retract as intended)

  Yes

  No

  N/A

• ☐ Pinch hazards are guarded (including rollers)

  Yes

  No

  N/A

• ☐ Machine specific LOTO procedures are posted near-by

  Yes

  No

  N/A

• ☐ Operating controls in good condition

  Yes

  No

  N/A

• ☐ Push sticks positioned near table saws

  Yes

  No

  N/A

Electrical

• ☐ Electrical cords and plugs have no visible damage (prongs present and not bent, cord sheath and insulation covers wires, cord not deformed)

  Yes

  No

  N/A

• ☐ Extension cords are only used for portable power tools or short-term power supplies and are the right size (gauge & length) for equipment used. Extension cords should not be daisy-chained or run beneath carpet.

  Yes

  No

  N/A

• ☐ Electrical outlets and switches are secured, wires are covered, and no ground plug is broken off in the outlet.

  Yes

  No

  N/A

• ☐ Power strips are only used in office areas for computers and printers.

  Yes

  No

  N/A

• ☐ Electrical panels unblocked for an area of 3’, panel doors are closed, and openings are covered.

  Yes

  No

  N/A

Housekeeping

• Walkways & working surfaces are free from slip/trip hazards.

  Yes

  No

  N/A

• No Portable Heaters.

  Yes

  No

  N/A

• Waste is discarded in appropriate containers.

  Yes

  No

  N/A

• Ensure there are no protruding objects that would present a trip or cut hazard for pedestrians.

  Yes

  No

  N/A

Chemicals

• ☐ Primary & secondary chemical containers are properly labeled.

  Yes

  No

  N/A

• ☐ Flammable chemicals stored in a closed, fire-proof cabinet.

  Yes

  No

  N/A

• ☐ Soiled rags & wipes are stored in red, closing container.

  Yes

  No

  N/A

• ☐ SDS Books are accessible

  Yes

  No

  N/A

Ladders

• Inspection Tags indicate an inspection within the last month.

  Yes

  No

  N/A

• Ladders are stable, clean, and free of damage.

  Yes

  No

  N/A

• Ladders not modified in any way.

  Yes

  No

  N/A

Mezzanines and Scaffolds

• ☐ Working surfaces above 48” have fall protection. (guardrails or personal fall protection devices)

  Yes

  No

  N/A

• ☐ Stairs & walkways unobstructed and clear of slip/trip hazards.

  Yes

  No

  N/A

• ☐ Gates operate freely and are not secured in the open position.

  Yes

  No

  N/A

• ☐ Guardrails free from damage & chains used as guardrails are 39-45” at the lowest point.

  Yes

  No

  N/A

Material Storage

• ☐ Storage racks are sturdy, secured and in good condition.

  Yes

  No

  N/A

• ☐ Items stacked over 48” are secured to prevent material from falling.

  Yes

  No

  N/A

• ☐ Finger racks end-stops installed.

  Yes

  No

  N/A

• ☐ Stored walls secured to prevent falling.

  Yes

  No

  N/A

• ☐ Gas bottles stored securely and protected from damage.

  Yes

  No

  N/A

• ☐ Power tools in good condition & free from alteration (triggers & safety devices function properly).

  Yes

  No

  N/A

Dust Control

• ☐ Air hoses free from damage.

  Yes

  No

  N/A

• ☐ Dust accumulation less than 1/16” (thickness of a quarter).

  Yes

  No

  N/A

• ☐ Table saw connected to dust collector.

  Yes

  No

  N/A

• ☐ Miter/chop saw either covered by box/shroud or connected to dust collector.

  Yes

  No

  N/A

• On-tool dust extraction devices with spark arrestor is used on grinder.

  Yes

  No

  N/A

• Dust collector hoses and bags are connected and damage-free.

  Yes

  No

  N/A

Routine Inspections

• ☐ Are forklift daily inspections documented?

  Yes

  No

  N/A

• ☐ Are scaffold monthly inspections documented?

  Yes

  No

  N/A

• ☐ Hoist & crane inspections noted on tags

  Yes

  No

  N/A

Other

• Employees warned of scaffold moves.

  Yes

  No

  N/A

• Personal fall arrest devices used in unguarded situations.

  Yes

  No

  N/A

• Interior & exterior lighting is sufficient.

  Yes

  No

  N/A

• Air tanks & pressure vessels free from rust and leaks.

  Yes

  No

  N/A

SAFETY ALERT ITEMS

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Maintenance

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• Notes:

• Inspection Conducted by Safety Coordinator

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• Inspection Reviewed by Plant Manager

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• Inspection Reviewed by Maintenance

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