Information
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.
-
8. MHE 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 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.
-
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.
-
15. Are all bulk stack locations stacked securely, safely and or in good condition.
-
Enter reason for grade.
-
Date / Time Facility SAFETY Walk completed:
-
Take note of the number of points scored, before proceeding to next section.
Acknowledgement
Overall Assessment
-
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:
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)
-
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:
