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.

  • Date / Time Facility SAFETY Walk completed:

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

Acknowledgement

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:

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:

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