Gemba Walk Checklist

• Client Name

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

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 (if required)

  Yes

  No

  N/A

• Other required PPE?

  Yes

  No

  N/A

HVAC

• Are the vents free and clear of debris?

  Yes

  No

  N/A

• Are their any noticeable leaks in the area?

  Yes

  No

  N/A

• Is their any load noises(rattling, screeching or whistling) coming from unit or vents?

  Yes

  No

  N/A

Safety Shower / Eye Wash Station

• Is their a shower or eye station located where acids / bases (corrosives) used?

  Yes

  No

  N/A

• Are they inspected monthly and access not blocked

  Yes

  No

  N/A

Emergency Exits

• Aisles and emergency exits not blocked

  Yes

  No

  N/A

Electrical

• Is voltage indicated on electrical control enclosures, power cabinets,, junction boxes etc?

  Yes

  No

  N/A

• Clearance in front of electrical enclosures36" (0-150v) and 42" (151-600v)?

  Yes

  No

  N/A

• Chords are free from frays and damage.

  Yes

  No

  N/A

• GFCI's required on portable electric tools and in areas where wetness or damage to cord is possible

  Yes

  No

  N/A

• Are knockout plugs present on all electrical enclosures?

  Yes

  No

  N/A

Material Storage Area

• Material organized and stored in proper location?

  Yes

  No

  N/A

Flammable Cabinets

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

  Yes

  No

  N/A

• No more than 3 cabinets within 100 square feet

  Yes

  No

  N/A

Environmental

• Are any spills or leaks present?

  Yes

  No

  N/A

Fit and Finish

• Is ceiling tiles clear of stains?

  Yes

  No

  N/A

• Is the paint on the walls in good condition?

  Yes

  No

  N/A

Walking / Working surfaces

• Are the walkways clear and free of debris?

  Yes

  No

  N/A

• Are any holes or floor opening not guarded?

  Yes

  No

  N/A

Fire Extinguishers

• Monthly Inspection completed / Verify completely charged

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Lockout / Tagout

• Are LOTO labels present?

  Yes

  No

  N/A

Doors and Glass

• Are doors in good condition? Be sure to check paint and door operation of the doors.

  Yes

  No

  N/A

• Are windows in are free of cracks ?

  Yes

  No

  N/A

• Do windows appear to be sealed properly?

  Yes

  No

  N/A

• Is the door closers leaking?

  Yes

  No

  N/A

Standard Work area

• Area clean & organized (less than 1 day of dirt)?

  Yes

  No

  N/A

• Aisles and emergency exits not blocked?

  Yes

  No

  N/A