Gemba Walk Checklist

• Audit Title

• Division

• Conducted on

  Date

• Prepared by

PPE & Safe Work Practices

• Correct PPE worn and is it in good condition?

  Yes

  No

  N/A

• Metatarsal safety shoes worn and are they in good condition

  Yes

  No

  N/A

• Hearing protection worn

  Yes

  No

  N/A

• Gloves worn?

  Yes

  No

  N/A

• Safety glasses worn?

  Yes

  No

  N/A

Lifting Devices

• Material lifting devices used and are they in good condition

  Yes

  No

  N/A

• Can operator explain daily inspection performed on lifting devices

  Yes

  No

  N/A

• Inspect lifting devices for worn or damaged devices

  Yes

  No

  N/A

Safety Shower / Eye Wash Station

• Are eye wash stations easily accessible?

  Yes

  No

  N/A

• Are they inspected monthly?

  Yes

  No

  N/A

Emergency Exits

• Aisles and emergency exits not blocked

  Yes

  No

  N/A

• Arc Flash label present on electrical control enclosures, power cabinets, junction boxes etc.

  Yes

  No

  N/A

• Clearance in front of electrical enclosures 36" (0-150v) and 42" (151-600v)

  Yes

  No

  N/A

• Chords are free from frays and damage

  Yes

  No

  N/A

• Extension cords only allowed for temporary situations <90 days. must be inspected annually

  Yes

  No

  N/A

Forklifts

• Are inspections being completed on equipment, prior to being used before each shift

  Yes

  No

  N/A

• Team members trained and license current within 3 years?

  Yes

  No

  N/A

• Seatbelt used whenever forklift operated?

  Yes

  No

  N/A

Material Storage Area

• Material organized and rotated by date

  Yes

  No

  N/A

• Material not triple stacked, only two high

  Yes

  No

  N/A

Flammable Cabinets

• Only flammable liquids in cabinet (no paper, wood or plastic stored in cabinet)

  Yes

  No

  N/A

• Cabinets undamaged

  Yes

  No

  N/A

Machine Guarding

• Is point of operation (grinding wheel, etc.) protected such that inadvertent contact is prevented?

  Yes

  No

  N/A

• Flywheels, gears, shafts, pulleys, belts, gears, sprockets, chains and couplings guarded to protect employees

  Yes

  No

  N/A

• E-stop button present

  Yes

  No

  N/A

Walking / Working surfaces

• Are the walkways clear and free of debris

  Yes

  No

  N/A

• Are all holes or floor openings guarded?

  Yes

  No

  N/A

Fire Extinguishers

• Monthly Inspection completed / Verify completely charged

  Yes

  No

  N/A

Confined space

• Marked with proper signage (permit required sign or non permit required sign

  Yes

  No

  N/A

HAZCOM

• All containers labeled. (Original container with Manufacturers Label or secondary container with HMIS label)

  Yes

  No

  N/A

• Do employees know how to access an MSDS for a chemicals used?

  Yes

  No

  N/A

Lockout / Tagout

• Is machine specific energy control procedure present?

  Yes

  No

  N/A

• Are LOTO labels present

  Yes

  No

  N/A

Compressed Gas Cylinder Storage

• Are cylinders identified with a durable label that clearly identifies the cylinder contents and gives a brief description of the potential hazard?

  Yes

  No

  N/A

• Cylinders secured with chain, lab strap or hard stock device located on the upper one third of the cylinder

  Yes

  No

  N/A

• Flammable gasses shall be stored at least 20 feet from oxidizers and any other source of ignition or separated by an approved firewall

  Yes

  No

  N/A

Do the employees know: (Interview a few people)

• How to report suggestions

  Yes

  No

  N/A

• Who to report incident or injuries to and how long they have to do it in "as soon as it happens"

  Yes

  No

  N/A