Facility / Audit Information

  • Facility Name:

  • General Manager:

  • Auditor Name:

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

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.

  • Enter reason for grade.

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

  • Enter reason for grade.

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

  • Enter reason for grade.

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

  • Enter reason for grade.

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

  • Enter reason for grade.

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

  • Enter reason for grade.

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

  • Enter reason for grade.

  • 16. Fire extinguishers are inspected monthly

  • Enter reason for grade

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

  • 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 PIT cab
    Demonstrating proper PIT operation when traveling loaded / unloaded

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

  • 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.

  • Enter reason for grade.

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

  • Enter reason for grade.

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

  • Enter reason for grade.

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

  • Enter reason for grade.

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

  • Enter reason for grade.



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:

  • Justification for RED assessment.

  • Signature of Safety Auditor:


  • 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)

  • 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:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.