Title Page
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Location
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Completed by
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Conducted on
PPE
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If Team Member(s) do not have correct PPE, ensure they retrieve it immediately.
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Do all Team Members have on the correct PPE? (i.e. Gloves, Ear Plugs, Protective Sleeves, Safety Glasses, etc...)
First Aid
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Is there an adequate number of First Aid trained Team Members available?
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Is the First Aid box properly stocked?
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Is the First Aid box properly mounted and in good repair?
Walking & Working Surfaces
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Are all Walking and Working Surfaces clear of obstructions and slip, trip, fall hazards? (i.e. Water in Floor, High Volumes of Dust, Steel, Floor Bolts, etc...)
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Are all Holes covered or repaired on the walking surface?
Fire Protection
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Are all Fire Doors clear from obstruction?
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Are all Fire Extinguishers the appropriate type and properly mounted in an accessible location?
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Did all Fire Extinguisher in this department pass inspection? (i.e. Arrow in the Green, No Major Dents, No Rust, etc...)
General Working Environment
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Are all Equipment Gauges clearly visible and free of cracks?
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Are JSAs posted?
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Are SOPs posted?
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Are there any leaking Hydraulic lines?
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Are there any leaking Air lines?
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Is the Workplace clean and sanitary? (i.e. Garbage / Trash)
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Proper housekeeping? (i.e. workplace is organized, free of tripping hazards, and other problems associated with a messy workplace do not exist)
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Are there any areas in need of a crossover?
Egress and Evacuation Routs
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Are escapeway Maps clearly marked if applicable?
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Are all Egress and Evacuation Routs free of obstruction and clearly marked?
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Are Exits labeled with an exit sign and properly illuminated so they are always visible?
Ladders
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Are all Ladders in good working condition and receive proper maintenance when necessary?
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Have all Team Members received training about how to properly and safely use ladders?
Hand Tools & Power Tools
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Are all Hand and Power Tools in good condition and functioning properly?
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When not in use, are Tools properly stored?
Machine Guarding
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Are all safety cages equipped with safety interlocks and or light curtains? (i.e. Cages and Hoop Drivers)
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Have all Hazards, at the point of operation, been guarded against? (i.e. Pinch Points, Ingoing Nip Points, Rotating Parts, etc...)
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Are all Machine hazards identified with proper warning decal? (i.e. Pinch Points, Moving Parts, Keep Hands Clear, etc...)
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Is all Machine Guarding in place and secured?
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Are E-Stops and power shut-offs within reach of the Machine Operator?
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Are all Emergency Stop Buttons red?
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Is there any area in need of Machine Guarding?
Lockout Tagout
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Have Team Members received LOTO Training?
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Are Authorized Team Members trained on how to de-energized and lockout their equipment?
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Are LOTO stations properly stocked? (i.e. Locks, Tags, Hasps, etc...)
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Are their LOTO procedure for all equipment that requires LOTO?
Forklifts
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Are Team Members who operate forklifts properly trained on the vehicles they use?
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Are Forklifts equipped with all safety parameters? (i.e. Functioning Horn, Back-Up Alarm, Blue Spotlight, etc...)
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Has Pre-Operations Inspection been completed before the forklift is operated?
Environmental Controls
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Do all work areas have adequate Lighting?
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Do all work areas have appropriate ventilation systems?
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Are all Hazardous Materials properly Identified?
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Is there an adequate drinking water dispenser located close to operators?
HAZCOM & Handling Combustible / Flammable Materials
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Are there proper storage containers and methods used to prevent spontaneous combustion of materials?
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Are all combustible waste, debris, and scrap stored in metal containers, and appropriately removed from the workplace?
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Are employees trained so they will understand the hazards of the materials? (i.e. Read SDSs, Properly Handling Techniques, etc...)
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Is proper PPE provided when handling certain hazardous materials?
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Is there a comprehensive list of hazardous substances in the workplace, and their corresponding SDS?
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Have Team Members been trained to understand OSHAs bloodborne pathogen standard?
Electrical
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Is all electrical equipment appropriately installed and receives regular maintenance?
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Are the appropriate labels used, for all devices that pose an electrical hazard? (i.e. Electrical / Breaker Boxes)
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Have all Team Members that work on or near electrical equipment received the proper training?
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Is all temporary wiring properly ran to not cause a tripping hazard? (i.e. Extension Cords)
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Are there any extension cords, that are in place, for permanent use?
Notes Section
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Please any Notes and Comments: