Facility Safety Assessment

• Inspector

• Conducted on

  Date
• Location
  Address

AISLES/EXITS/EGRESS

• Minimum width of any aisle leading to an exit is at least 44 inches wide

  Yes

  No

  N/A

• Are exits marked, free of debris and readily accessible at all times?

  Yes

  No

  N/A

• Is emergency lighting operating?

  Yes

  No

  N/A

• Can you see marked exits or exit signs from the aisles in your area?

  Yes

  No

  N/A

• Are aisles and doorways kept clear; and free of obstructions with trip hazards minimized to permit visibility and movement?

  Yes

  No

  N/A

• Are doors not used for egress (closets, offices, etc) that could incorrectly be thought to be an exit labeled “NOT AN EXIT?”

  Yes

  No

  N/A

• Are floor surfaces clean, dry, level, not slippery or sticky and in good condition?

  Yes

  No

  N/A

COMPRESSED GAS CYLINDERS

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

  Yes

  No

  N/A

• Are cylinders stored away from heat source and do they have separation between flammables and oxidizers?

  Yes

  No

  N/A

• Are cylinders located or stored in a manner to prevent them from falling over? This includes empty containers which must have their protective cap in place.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are flammables and combustibles stored properly?

  Yes

  No

  N/A

EMERGENCY, HEALTH, AND SAFETY INFORMATION

• Are area hazard signs visible, legible, understandable?

  Yes

  No

  N/A

• Are procedures established for alerting employees of an emergency in the workplace (i.e., fire, shelter, evacuation, etc.)?

  Yes

  No

  N/A

• Are fire alarm pull station locations marked and unobstructed?

  Yes

  No

  N/A

• Are signs with emergency numbers, routes, and evacuation plans posted?

  Yes

  No

  N/A

• Is a copy of the Emergency Action Plan (EAP) for the area available for employees to read?

  Yes

  No

  N/A

• Are employees trained on emergency procedures? Do they know where to assemble in case of an emergency?

  Yes

  No

  N/A

FIRE EMERGENCY

• Are fire extinguishers fully charged and have current inspection dates?

  Yes

  No

  N/A

• Are fire extinguishers mounted, visible, and accessible?

  Yes

  No

  N/A

• Do employees know where the fire extinguishers are and how to use them?

  Yes

  No

  N/A

• Are fire suppression devices (fire extinguishers, deluge systems, monitors, hydrants, hoses cabinets, hoses, etc.) appear to be in good operating condition?

  Yes

  No

  N/A

FIRE PREVENTION

• Are “NO SMOKING” areas enforced?

  Yes

  No

  N/A

• Are electrical outlets or cords not overloaded? Only allowable number of connections (i.e., a 4-way outlet only has 4 pieces of equipment connected and not loaded with additional extension cords).

  Yes

  No

  N/A

• Are fire sprinkler heads unobstructed and free of dirt and corrosion?

  Yes

  No

  N/A

FLAMMABLES/COMBUSTIBLES

• Are hazardous materials properly stored?

  Yes

  No

  N/A

• Are chemicals properly stored and returned to appropriate cabinet at end of shift?

  Yes

  No

  N/A

• Are aerosol cans in good condition (no corrosion, damage, etc.)? If not in use, are they stored in the appropriate flammable/combustible cabinets?

  Yes

  No

  N/A

• Are flammable cabinets grounded and in good condition?

  Yes

  No

  N/A

• Are flammable liquids stored in approved safety containers?

  Yes

  No

  N/A

• Are materials that could burn kept away from ignition sources?

  Yes

  No

  N/A

• Is area free of excessive trash or combustibles?

  Yes

  No

  N/A

• Are the tops of the flammable / combustible cabinets clear (nothing stored on top)?

  Yes

  No

  N/A

• Are all flammable bottle tips unmodified and/or undamaged?

  Yes

  No

  N/A

• Is heat producing equipment turned off at night when no one is present?

  Yes

  No

  N/A

HOUSEKEEPING/WORK ENVIRONMENT

• Are desk/work and storage areas clean, organized, and sanitary?

  Yes

  No

  N/A

• Are trash containers (large 55 gallon) covered? If less than 55 Gal, are they maintained appropriately?

  Yes

  No

  N/A

• Are electrical/network cables organized to eliminate trip hazards?

  Yes

  No

  N/A

• Are drawers of desks and file cabinets kept closed when not in use?

  Yes

  No

  N/A

• Are file cabinets arranged so drawers do not open into aisles?

  Yes

  No

  N/A

• Is only one file drawer opened at a time?

  Yes

  No

  N/A

• Is knife blade on paper cutter lowered and latched when not in use?

  Yes

  No

  N/A

• Is required lighting operational and/or appear adequate for the area and work performed?

  Yes

  No

  N/A

• Are floor openings covered and secure?

  Yes

  No

  N/A

• Are spilled or dropped items cleaned up and put away?

  Yes

  No

  N/A

• Are guardrails installed, free of corrosion or obvious discrepencies , and visibly in good condition?

  Yes

  No

  N/A

SECURITY ITEMS

• Do employees have proper ID badges?

  Yes

  No

  N/A

• Do contractors/vendors have proper ID badges?

  Yes

  No

  N/A

• Are visitors escorted and have proper ID badges?

  Yes

  No

  N/A

• Are contractors and visitors displaying their ID badges?

  Yes

  No

  N/A

• Are doors that should be secure not being propped open?

  Yes

  No

  N/A

STRUCTURES

• Ceiling tiles are not damaged, loose, or missing?

  Yes

  No

  N/A

• All overhead hazards have been identified?

  Yes

  No

  N/A

ENVIRONMENTAL

CLEAN AIR ACT COMPLIANCE

• Are any solvent contaminated rags lying about in the work area?

  Yes

  No

  N/A

• Are solvent contaminated rags properly disposed of?

  Yes

  No

  N/A

• Have all open top solvent pump cans been removed from the work area?

  Yes

  No

  N/A

• Are containers, solvent dispensing containers, paint gun cleaning containers,<br>and solvent dispensing bottles closed when not in use?

  Yes

  No

  N/A

CLEAN WATER ACT COMPLIANCE

• Employees do not dump wastes into drains or sinks unless authorized (including wash water and mop water)

  Yes

  No

  N/A

• No wastes dumped outside or in storm sewers or catch basins?

  Yes

  No

  N/A

• Are pipes, pumps, hoses, and valves free of leaks or defects?

  Yes

  No

  N/A

• Do sumps, pits, lift station containment valves remain dry?

  Yes

  No

  N/A

• Are spills and leaks attended to and reported when required?

  Yes

  No

  N/A

HAZARDOUS/NON-HAZARDOUS WASTE COMPLIANCE

• Are hazardous waste containers properly identified and labeled with the words, “HAZARDOUS WASTE?”

  Yes

  No

  N/A

• Are used oil collection containers properly identified and clearly labeled with the words, “USED OIL?”

  Yes

  No

  N/A

• Are controlled and non-hazardous wastes being collected and managed properly (i.e., laundry, coolant sludge, composite waste, batteries, flourescent lamps)?

  Yes

  No

  N/A

• Are containers properly identified and clearly labeled with contents?

  Yes

  No

  N/A

• Are hazardous waste collection containers fully closed while not in use?

  Yes

  No

  N/A

• Are used oil waste containers closed while not in use?

  Yes

  No

  N/A

• Are trash cans free of hazardous waste?

  Yes

  No

  N/A

• Are trash cans free of scrap metal?

  Yes

  No

  N/A

• Is there less than 55 gallons per waste stream at satellite accumulation area(s)?

  Yes

  No

  N/A

• Are hazardous waste satellite accumulation area signs in place?

  Yes

  No

  N/A

• Are employees familiar with the waste materials generated in the work area and the proper disposal method(s)?

  Yes

  No

  N/A

• Are proper absorbent materials on hand for spills?

  Yes

  No

  N/A

• Is waste removed in a timely manner?

  Yes

  No

  N/A

SAFETY

EMPLOYEE WORK PRACTICES

• Are employees and contractors free from metal jewelry or other items that could get pulled into rotating equipment when around machinery?

  Yes

  No

  N/A

• Is the Safe Work Permit available and correctly filled out for any work being performed in area?

  Yes

  No

  N/A

ELECTRICAL EQUIPMENT MARKINGS

• Do circuit breakers clearly indicate whether they are in the “ON” or “OFF” position and are switch panels clearly marked?

  Yes

  No

  N/A

• Is electrical panel access clear – 36 inches clearance in front of panel?

  Yes

  No

  N/A

• Is equipment intended for long-term use hard wired into permanent facility wiring?

  Yes

  No

  N/A

• ELECTRICAL GROUNDING

  Yes

  No

  N/A

• Are electrical appliances, portable electrical tools, and fixed electrical equipment grounded or UL rated/double insulated and in good repair?

  Yes

  No

  N/A

• Do extension cords (in use and stored) have a grounding conductor and are in good condition (no cuts, kinks, missing prongs, etc.)?

  Yes

  No

  N/A

• Are extension cords used only for temporary wiring applications?

  Yes

  No

  N/A

EQUIPMENT

• Proper guarding of any pinch points, rotating collars, cams, chucks, couplings, shafts flywheels, spindles, bolt ends, rotating mechanisms, etc?

  Yes

  No

  N/A

• Are all protective guards (including light curtains and interlocks) in place, effective, and checked daily or before use?

  Yes

  No

  N/A

• Are all controls and emergency stops clearly identified and within reach of operator?

  Yes

  No

  N/A

• Are all emergency stops, safety guards, and safety devices located on equipment and tools working and adjusted properly?

  Yes

  No

  N/A

• Are grinder gaps 1/8 inch from bottom of wheel and 1/4 inch from top of wheel?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• No aluminum found in grinding wheel surface?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are heat lamp and work light bulbs guarded?

  Yes

  No

  N/A

• Are all fixed machines bolted to the floor?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are air disconnects and safety nozzles the correct type?

  Yes

  No

  N/A

• Air lines and hydraulic lines free of damage?

  Yes

  No

  N/A

ERGONOMICS

• Ergonomic problems observed with workstation, keyboard, posture, or work habits?

  Yes

  No

  N/A

• Employees are advised on the proper lifting techniques?

  Yes

  No

  N/A

• Are mechanical lifting aids available for heavy or awkward items?

  Yes

  No

  N/A

EYEWASH STATION

• Eyewash / Shower Station's is clean, operational, and missing no equipment?

  Yes

  No

  N/A

• Eyewash / Shower Station's is located in a way that assures free and unimpeded access?

  Yes

  No

  N/A

FORKLIFT/INDUSTRIAL TRUCKS – DAILY INSPECTION

• Daily visual inspection performed prior to use? Is monthly inspections documented and filed?

  Yes

  No

  N/A

• Do all operators have current qualification?

  Yes

  No

  N/A

• Are service valves closed on all propane equipment left inside overnight?

  Yes

  No

  N/A

• Harness and lanyard used at all times with scissor-lift, aerial platform, etc?

  Yes

  No

  N/A

• Are Powered Industrial Trucks (PIT's) driven backwards with awkward or bulky loads?

  Yes

  No

  N/A

• Are all traffic signs observed? (Operators must stop at stop signs.)

  Yes

  No

  N/A

• Are pedestrians given the right-of-way?

  Yes

  No

  N/A

• Are safety glasses and seatbelt worn while operating the truck?

  Yes

  No

  N/A

HAZARD COMMUNICATION – CHEMICAL SAFETY

• Do employees know what an SDS (Safety Data Sheet) is, where to find them, and how to use them?

  Yes

  No

  N/A

• Is each container of hazardous chemicals in the work area properly labeled by<br>identifying the chemical it contains and marked with health hazards?

  Yes

  No

  N/A

• Are all chemicals that are used in the facility listed in the Online SDS Management System and available?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

HOIST/CRANES/LIFTING DEVICES

• Are all slings, hoists, chains, jacks, and supports certified and tagged with load limits and inspection dates?

  Yes

  No

  N/A

• Is the weight of all loads known and is the crane visually inspected before use? Is the monthly inspection documented and filed?

  Yes

  No

  N/A

• Is there a full, unrestricted view for operator before lifting load?

  Yes

  No

  N/A

• Are all loads being lifted overhead secured?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Does the crane operator have a current license or certificate (for crane operation and rigging applications)?

  Yes

  No

  N/A

LADDERS/SCAFFOLDING

• Are all rungs or steps on ladders present and in good condition?

  Yes

  No

  N/A

• Are all labels present and legible on ladders?

  Yes

  No

  N/A

• Is ladder inspection attached and current?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 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)?

  Yes

  No

  N/A

• Are fixed stairs being used (instead of ladders) where regular travel is needed?

  Yes

  No

  N/A

PERSONAL PROTECTION EQUIPMENT (PPE): EYE AND FACE/RESPIRATORY/HEARING

• Are high-noise areas clearly marked with "Hearting Protection Required" signs or messaging?

  Yes

  No

  N/A

• Is hearing protection devices readily available close to work area?

  Yes

  No

  N/A

• Are the hearing protection devices dispensers clean, maintained, and stocked?

  Yes

  No

  N/A

• Are approved safety glasses, face shields, side-shields, gloves, aprons, FRC clothing, and hearing protection used in required areas?

  Yes

  No

  N/A

• Are employees using appropriate respirators for the work being done?

  Yes

  No

  N/A

• Are respirators clean and stored properly?

  Yes

  No

  N/A

• Are employees using respirators clean-shaven (so mask will seal against face)?

  Yes

  No

  N/A

• Are employees trained and knowledgable in their proper use?

  Yes

  No

  N/A

• Are Escape Respirators clean, full, and stored properly? Inspection current?

  Yes

  No

  N/A

PPE: FALL PROTECTION

• Is appropriate fall protection provided and used properly (safety harness, lanyard, and if needed, self-retracting lifeline)?

  Yes

  No

  N/A

• Is fall protection PPE stored properly, kept clean, and out of direct sunlight?

  Yes

  No

  N/A

• Is fall protection inspected before each use, documented and filed monthly, and certified annually?

  Yes

  No

  N/A

• Are the employees Trained and certified for the specific fall protection use? Visually verified by seeing certification card or training roster?

  Yes

  No

  N/A

WALKING SURFACES/STAIRS

• Are all floor tracks / sumps covered?

  Yes

  No

  N/A

• Is the angle of fixed stairs within 30 to 50 degrees?

  Yes

  No

  N/A

• Are non-slip surfaces in good condition on steps and platforms?

  Yes

  No

  N/A

• Are stairwells clear and handrails in good condition?

  Yes

  No

  N/A

• Are mobile work platforms available and used?

  Yes

  No

  N/A

Representatives

• SSCA Representative

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