Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
Outside Grounds
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Are walkways clear of obstacles that could cause a tripping hazard?
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Are parking lots free of tripping hazards?
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Are parking lots free of obstruction for vehicles to pass through aisles?
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Are walkways, parking lots, and stairs kept free of snow and ice?
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Is parking lot lighting adequate?
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Are walkways & parking lots free of trash?
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Are smoking areas clean of cigarette buds & trash
Housekeeping
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Are floors and aisleways kept clean?
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Is bulk storage stacked according to recommendations on packaging (i.e. number of units stacked on top of each other)?
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Are any bulk storage units leaning/callapsing?
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Are floors and walkways free of slip/trip/fall hazards?
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Are all tools and cleaning materials stored in their proper places?
Fire Safety
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Are all EXIT ways clear and unobstructed?
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Are all EXIT signs lighted?
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Are fire extinguishers inspected monthly?
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Are all fire extinguishers clear and unobstructed?
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Does the emergency lighting operate?
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Are all fire doors (stairway doors) kept closed?
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Is the evacuation plan up-to-date?
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Are the evacuation routes posted?
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Is all staff trained on the evacuation plan?
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Are emergency numbers posted?
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Have the evacuation wardens been properly trained?
Electrical Safety
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Are all electrical outlet covers in place?
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Are all cords out of the way of walking surfaces?
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Are all cords and plugs in good condition?
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Is the use of extension cords prohibited?
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Do all electrical cords look safe (not frayed or cut)?
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Are all "breaker panels" marked?
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Is all equipment properly grounded?
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Are ground fault circuit inperrupters (GFCI) within 6 feet of sinks?
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Is there at least 3 foot clearance in front of breaker panels?
Chemical Hazards
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Is the chemical inventory up-to-date?
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Are safety data sheets available and current?
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Do outside companies supply SDS's when working in or around the building with chemicals?
Severe Weather
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Is there adequate shelter available for all associates?
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Is the shelter well identified and marked?
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Does this facility have access to a weather radio?
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Does this facility have a severe weather alarm or alert to notify associates?
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Are alert sirens, or means of notification, in working condition?
First Aid
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Are first aid kits properly stocked & marked?
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Are Bloodborne Pathogen (BBP) spill kits available and up-to-date?
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Does this facility have one designated first responder for each shift?
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Are the first responders up-to-date on training?
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Does this facility have an AED and is it being checked monthly to ensure it is functional?
Personal Protective Equipment
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Are PPE assessments completed at this facility and up-to-date?
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Does the facility have all required PPE?
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Have all the associates in this facility been properly trained on PPE?
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Do all associates know how to get the proper PPE?
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Are associates using the proper PPE for the job?
Forklifts & Battery Charging Areas
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Are forklift inspection sheets filled completed each shift?
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Are forklifts placed out of service if they are in need of repair, defective, or in any way unsafe?
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Are proper eye wash stations provided in forklift battery charging areas (15 minute continuous flow required)
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Are eyewash stations properly inspected (fluid changed every 90 days if not a cartridge system)?
Other Findings / Hazards (use to identify hazards that may not be found in the previous sections)
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Finding #1
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Finding #2
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Finding #3
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Finding #4
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Finding #5