Facility SAFETY Walk

Facility / Audit Information

• Facility Name:

• General Manager:

• Auditor Name:

• Select Date / Time Facility SAFETY Walk started (before selecting START below)

  Date

Assessment Criteria

• Grade Safety Walk elements using the following standard:
  Green - Excellent condition during inspection
  Yellow - Minor discrepancies exist
  Red - Significant issues observed and noted
  N/A - Not Applicable or Not Observed
  
  Safety Walk Auditor is encouraged to take pictures in support of RED assessment grades.

• 1. Cords and hoses are in good condition.

  Green

  Yellow

  Red

  N/A

• Enter reason for grade.

• 2. Cords and Hoses are properly stored and arranged to prevent tripping hazard.

  Green

  Yellow

  Red

  N/A

• Enter reason for grade.

• 3. Extension cords are only being used as a temporary power source.

  Green

  Yellow

  Red

  N/A

• Enter reason for grade.

• 4. Pallets are wrapped and stored properly in designated warehouse locations.

  Green

  Yellow

  Red

  N/A

• Enter reason for grade.

• 5. Floors are swept and in good condition, free of water, ice, debris and dirt.

  Green

  Yellow

  Red

  N/A

• Enter reason for grade.

• 6. All warehouse lights are in proper working order.

  Green

  Yellow

  Red

  N/A

• Enter reason for grade.

• 7. Exit doors and fire extinguishers are not blocked and accessible for use.

  Green

  Yellow

  Red

  N/A

• Enter reason for grade.

• 8. MHE operators observed following safe operating practices and procedures.

  Green

  Yellow

  Red

  N/A

• Enter reason for grade.

• Practices include:
  Sounding Horns
  Stopping at intersections
  Observing right-of-way
  Maintaining safe travel distances from pedestrians
  Operating with body parts in MHE cab
  Demonstrating proper MHE operation when traveling loaded / unloaded

• 9. Lift Truck Operators give proper distinctions when putting pallets away and bringing pallets down from upper storage locaitons.

  Green

  Yellow

  Red

  N/A

• Enter reason for grade.

• 10. Check racking for any equipment-related damage that may not have been reported. Report any suspected abuse to equipment and facility.

  Green

  Yellow

  Red

  N/A

• Enter reason for grade.

• 11. LTO's observed using Fall Prevention systems properly, when appropriate.

  Green

  Yellow

  Red

  N/A

• Enter reason for grade.

• 12. Personnel Protective Equipment (PPE) is up to code and stored in properly location, when not in use.

  Green

  Yellow

  Red

  N/A

• Enter reason for grade.

• 13. Associates observed using proper lifting techniques, as appropriate to work assignment.

  Green

  Yellow

  Red

  N/A

• Enter reason for grade.

• 14. All visitors are wearing safety vest or orange jackets.

  Green

  Yellow

  Red

  N/A

• Enter reason for grade.

• Date / Time Facility SAFETY Walk completed:

  Date

• Take note of the number of points scored, before proceeding to next section.

Overall Assessment

• Select points achieved during SAFETY Walk (Minimum - 0 / Maximum - 28)

• Grading Overall Assessment (Maximum points attainable from Audit Section - 28)
  Overall GREEN - 25 to 28 points (90-100%)
  Overall YELLOW - 21 to 24 points (75-89%)
  Overall RED - 20 points or less (< 75%)

• Overall Assessment based on Safety element grades:

  Green

  Yellow

  Red

  N/A

• Justification for RED assessment.

• Signature of Safety Auditor:

  Sign

Acknowledgement

• Reviewed and concur with SAFETY Walk assessment.

• Reviewed and do not concur with SAFETY Walk assessment.

• Reason for not concurring:

Agreed SAFETY Walk deficiencies, requiring immediate corrective action.

• Are there deficiencies requiring immediate corrective action? (On for Yes)

  Off

  On

• Item 1. (check, if required)

• Item 1. discrepancy:

• Assigned to:

• Item 2. (check, if required)

• Item 2. discrepancy:

• Assigned to:

• Item 3. (check, if required)

• Item 3. discrepancy:

• Assigned to:

• Signature of General Manager:

  Sign