Facility Safety Audit (Revised 10/21/2013)

• Name of facility being audited:

• Month and Year of Audit

• Conducted on

  Date

• Prepared by

LOTO

• Are there any locks being used for unauthorized purposes?

  No

  Yes

  Partial

  N/A

• Add media

  Media

• Is equipment de-energized while being repaired or adjusted?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Do all employees have their Locks/tags in place while working on equipment?

  Yes

  No

  Partial

  N/A

• Add media

  Media

Compressed gas 1910 Subpart M

• Do empty cylinders have their valves closed? 1910.253(b)(2)(iii)

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Are compressed gas cylinders stored to prevent tipping or falling?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Are compressed gas cylinders capped with a metal protecting cover when not in use?

  Yes

  No

  Partial

  N/A

• Add media

  Media

Chemical handling and storage 1910.120

• Are secondary bottles labeled to meet HMIS OR GHS compliance with HMIS or pictogram to indicate hazards along with first aid and specific hazard warning instructions.

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Are chemicals being handled and stored in a safe manner? ( i.e. containers closed when not in use, stored in flammable cabinets if applicable, etc.)

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Are metal flammable storage drums grounded properly to prevent sparks and fire.

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Are open drums and containers stored on spill containment pallets or pans.

  Yes

  No

  Partial

  N/A

• Add media

  Media

Dock and warehouse safety 1910 Subpart N

• Loading area clean and tidy to prevent falling objects, slips trips or fall hazards?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Pallets must be in good condition. Empties must be stored properly. No broken or protruding wood or nails. No pallets on edge. Avoid storing empty pallets in quantities or densities in excess of O.H. fire sprinkler combustible load ratings.

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Are rack uprights bolted to floor to prevent tipping or falling?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Are rack uprights and beams in good condition? Bent racks and beams must be repaired or replaced.

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Aisles and forklift zones are indicated to protect pedestrians.

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Guardrails and/or covers are provided to protect personnel from the hazards of open sides of stairs, platforms, floor openings, floor holes, mezzanines, equipment pits, and other possible fall hazards.

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Fall hazards are protected with restraint and signage.

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Wheel chock required and utilized when loading or unloading trailers with forklifts?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Are open docks with a fall hazard that exceeds 36" protected with a restraint and warning signage?

  Yes

  No

  Partial

  N/A

• Add media

  Media

Ergonomics Title 8 section 5110 and 5(a)(1) (GDC)

• Are mechanical assists available to the worker performing materials-handling tasks?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Are tools, instruments, and machinery shaped, positioned, and handled so that tasks can be performed comfortably?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Are workers exposed to excessive vibration from tools or equipment?

  No

  Yes

  Partial

  N/A

• Add media

  Media

• Are chairs and work benches adjusted, positioned, and arranged to minimize strain on the body?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Are pressure points on body parts such as wrists, forearms, backs of thighs avoided?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• If workers have to push or pull objects using great amounts of force, are mechanical aids provided?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Is work arranged so that workers are not required to lift and carry too much weight?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Can employees keep their hands or wrists in a neutral position when they are working?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Can work be done without repetitive twisting, bending or lifting of the arms above the shoulder level?

  Yes

  No

  Partial

  N/A

• Add media

  Media

Housekeeping 1910.22

• Intersections kept clear of boxes etc?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Entry and walkways kept clear?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Walkways adequately and clearly marked?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Floor surfaces even and uncluttered?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Are footpaths in good condition?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Are fall preventive measures in place and used where gaps occur in railings?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Are railings in good condition?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Stair and risers kept clear?

  Yes

  No

  Partial

  N/A

• Add media

  Media

Emergency preparedness 1910.38

• Do you have spill kit or emergency supply's stored in a location that is safely accessible in an emergency evacuation?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Are emergency numbers posted and up to date in a conspicuous location?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Evacuation plan and maps displayed and understood by all employees?

  Yes

  No

  Partial

  N/A

• Add media

  Media

Emergency equipment 1910.157 and 120

• Are eyewash stations, showers and fire blankets available,inspected and working properly?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Are first aid kits available, applicable for the facility, stocked and readily available?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Spill kits available where required, inspected and adequate for amount and type of chemicals on site?

  Yes

  No

  Partial

  N/A

• Add media

  Media

Electrical safety 1910 Subpart S

• Were electrical panels and disconnects or junction boxes observed with open slots, uncapped conduit holes, discontinued circuits or uncovered wiring

  No

  Yes

  Partial

  N/A

• Add media

  Media

• Are electrical panels and disconnects labeled with amperage and voltage?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Are electrical panels, disconnects and breakers labeled as to what they control?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Are there any loose electrical cords that are not considered temporary and should be hard wired?

  No

  Yes

  Partial

  N/A

• Add media

  Media

• Do electrical panels and disconnects have 36" radial clearance for emergency access?

  Yes

  No

  Partial

  N/A

• Add media

  Media

Exits 1910 Subpart E

• Emergency exit lighting and illuminated exits in place and operable?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Is a clear path of egress visible from any point in the plant?( i.e., exits signs, direction/traffic flow signs leading to exit)

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Are Exits clear of obstructions?

  Yes

  No

  Partial

  N/A

• Add media

  Media

Fire Prevention 29 CFR 1910.39

• Evacuation plan displayed and understood by all employees?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Oily rags and combustible refuse in covered metal containers?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Are Fire Extinguishers clear of obstructions?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Are exit doors able to open from the direction of exit travel without the use of a key or special knowledge or effort?

  Yes

  No

  Partial

  N/A

• Add media

  Media

Forklifts and pallet jacks 1910.178

• Are pallet jacks stored under a pallet when not in use?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Are forks on lifts stored in the low position when parked?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Were any forklift hazards or unsafe acts observed?

  No

  Yes

  Partial

  N/A

• Add media

  Media

Machine guarding 1910 Subpart O

• Gears, sprockets, pulleys, and flywheels guarded?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Pinch points and inward running rollers are properly guarded?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Guards prevent worker’s hands, or any parts from making contact with moving parts?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Belts and chain drives guarded?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Machine controls within easy reach of the operator?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Foot trundle or foot pedal safety guards are in place.

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Guarding and/or switches have NOT been bypassed.<br>

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Guards in place are free of damage.

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Guards firmly secured and not easily removable.

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Point-of-operation guards provided and in place?

  Yes

  No

  Partial

  N/A

• Add media

  Media

Machine shop and maintenance area 1910.215, Subpart P,Q,O

• Are ladders and other equipment safely secured to prevent falling?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Are hand tools in safe working order?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• All grinders are properly adjusted (tool rest within 1/8" of wheel and tongue guard within 1/4" of wheel). Grinding wheel is smooth with no grooves.

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Is welding area free of clutter? Can welding be safely performed in this area?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Are welding/cutting cylinders stored properly? (Fuel and oxygen stored 20 feet apart, secured with chains, caps in place).

  Yes

  No

  Partial

  N/A

• Add media

  Media

Warning signs and labels 1910.16

• Warning signs, stickers or labels are placed in areas or on equipment to notify or warn employee of specific hazards.

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Are areas where PPE is critical and hazards are prevalent posted to remind workers to wear their assigned PPE.

  Yes

  No

  Partial

  N/A

• Add media

  Media

Personal protective equipment -PPE 1910.132

• Are workers using the PPE properly?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Are engineering controls in place to protect workers before PPE is utilized?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Fall protection PPE available where applicable and areas where required are posted to restrict access to trained personnel only.

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Are respirators or dust mask being utilized properly where applicable?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• PPE - Personal protective equipment is well stocked and available for the hazards present at this facility

  Yes

  No

  Partial

  N/A

• Add media

  Media

State and federal postings. DOL and State req.

• State and federal posters are current and the information that is required to be filled out by the employer is up to date.

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Are forklift safety rules posted in areas where forklifts are present.

  Yes

  No

  Partial

  N/A

• Add media

  Media

Office Area

• Work and storage areas are free of improper storage (e.g., heavy, high and/or unstable storage)

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Exit paths are free of boxes/materials at all times.

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Electrical cords and plugs are in good condition (i.e., not frayed, taped, spliced, or ground prong missing)

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Computer work stations and work area are ergonomically correct and workers are working safely

  Yes

  No

  Partial

  N/A

• Add media

  Media

• 36” clearance is maintained in front of all electrical panels and fire extinguishers

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Aisles, walkways, and work areas are free of trip and fall hazards (i.e. torn carpets, turned up edges of door mats, boxes etc.)

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Illuminated exit and emergency lighting working properly?

  Yes

  No

  Partial

  N/A

• Add media

  Media

• First aid kits and fire extinguishers available and inspected monthly.

  Yes

  No

  Partial

  N/A

• Add media

  Media

Safety Concerns and Suggestions (Section will not be scored)

• In the spaces provided, please make safety suggestions or address safety concerns. Please be as specific as possible.

• Add media

  Media

• Add media

  Media

• Add media

  Media

• Add media

  Media

Miscellaneous

• Only approved Safety knives are being used.

  Yes

  No

  Partial

  N/A

• Add media

  Media

• No missing rollers on conveyors.

  Yes

  No

  Partial

  N/A

• Add media

  Media

• Compressed air hoses have nozzles that meet OSHA requirements ( 30 psi with holes at end of nozzle).

  Yes

  No

  Partial

  N/A

• Add media

  Media

Unsafe Act or Condition

• Was an unsafe act observed?

  Select No Yes

  • No
  • Yes

• Was an employee or manager involved?

  Employee

  Manager

  Temp employee

• Description of unsafe act

• Department or Area

• Equipment or machine involved

• Spoke with employee and reported to manager

• Had to stop employee and council on safe procedures

• Photo of issue

  Media

• Name

• Description of unsafe act

• Spoke with manager involved

• Add media

  Media

• A contractor or visitor was involved

• Name if possible

• Company

• Description of unsafe act

• Add media

  Media

• Unsafe condition

Element

• Was an unsafe condition observed?

  No

  Yes

• Describe the unsafe condition

• Photo

  Media

• Reported to manager

• By signing below, you acknowledge the following statement:
  
  "This audit was completed to the best of my ability. All questions were answered honestly and accurately."
  
  

• Type and Sign your name here.

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