Information

  • Client / Site

  • Date

  • Prepared by

  • Location

  • Additional staff attending

General Work Areas

  • Are work areas clean and free of debris?

  • Are OSHA, Fed and State posters in a prominent location?

  • Are Emergency Phone numbers posted where they can be readily found??

  • Are Safety and warnings posted where appropriate?

  • Is a First Aid kit available, adequately stocked and inspected monthly?

  • Is the OSHA 300A form posted between 2/1 and 4/30?

  • Are trash cans emptied daily?

  • Are adequate toilet and washing facilities provided?

  • Is potable water provided for drinking, washing, and cooking?

  • Are water outlets that are not suitable for drinking clearly identified?

  • Are toilet and hand washing areas clean and sanitary?

  • Is lighting appropriate for the work area?

Medical Services/First Aid

  • Has annual training been conducted on the Site Specific Bloodborne Pathogen Plan?

  • Do Residential life staff, Custodial, First Aiders and/or Security work in this area?

  • Have Residential life staff, Custodial, First Aiders and/or Security been trained for elevated risk?

  • Records of Hep shot series or waivers of delination complete for all employees identified. (Residential life staff, Custodial, First Aiders and/or Security been trained for elevated risk)

  • Is blood borne waste disposed of correctly? ( per the plan)

  • Are sharps containers supplied?

  • Is one employee in each work area qualified to give first aid if medical aid is not nearby?

  • Are medical professionals readily available for advice and consultation?

  • Are eye wash and quick drench showers available if corrosives are being used in the work area?

  • Are they marked and functional?

  • Are stations inspected monthly?

  • Is the eyewash fluid changed every 6 months?

Fire protection

  • Are fire suppression systems inspections current?

  • Is the Fire alarm system tested annually?

  • Is the local fire dept aquatinted with the work area and facility?

  • Are interior standpipes and valves inspected regularly?

  • Are Fire doors maintained and inspected regularly?

  • Are automatic sprinkler system control valves inspected?

  • Do sprinkler risers have a 3 ft buffer zone?

  • Do sprinkler heads have 18” clearance above stored materials?

  • Are Fire extinguishers of the proper type, appropriate number and in readily accessible locations?

  • Do all Fire extinguishers have current inspections, both monthly and annual?

  • Do all extinguishers have a 3 ft buffer?

  • Are Fire Extingushers inspected Annually?

  • Are Fire Extingushers inspected monthly?

Exit routes

  • Are all exit routes that are subject to blackout protected by emergency lights?

  • Do the emergency lights work?

  • Are doors, passageways, or stairways that are neither exits nor accessible to exits appropriately marked as “Not an Exit” or with an indication of its actual use?

  • Where exit doors to the exterior are not visible, are exit routes marked with exit signs or exit signs with arrows?

Walkways

  • Are aisles and passageways kept clear and clean?

  • Are pits and floor openings covered or guarded?

  • Are standard guardrails provided when the walkway surface is elevated more than 48 inches above any adjacent floor or ground?

  • Are walkways properly marked with sufficient aisle clearance provided for motorized or mechanical handling equipment operation?

Floor and wall openings

  • Does this location have Floor or Wall openings?

  • Are floor and wall openings protected with covers, grating or guard rails?

Stairs and Stairways

  • Are standard stair rails or handrails on all stairways with four or more risers?

  • Are stairways at least 22 inches wide?

  • Do stair landing platforms extend not less than 30 inches in the direction of travel, and extend 22 inches in width at every 12 feet or less of vertical rise?

  • Are step risers on stairs of a uniform height from top to bottom?

  • Are handrails located 30" to 34" off the stair tead and capable of withstanding a load of 200 pounds applied within 2 inches of the top edge and are midrails present?

Elevated Surfaces

  • Are signs posted showing the surface load capacity of shelving or other elevated storage areas?

  • Are surfaces that are elevated more than 48 inches above the floor or ground provided with standard guardrails?

  • Are elevated surfaces that expose people or machinery to falling objects provided with standard, 4-inch (nominal) toeboards?

Ladders

  • Are employees trained to inspected ladders visually before use and verified safe to use?

  • Are annual ladder inspections documented?

  • Where are the records kept?

  • Are ladders with broken or missing steps, rungs, or cleats; broken side rails; or faulty equipment removed from service?

  • When in use, do ladders extend at least 3 feet above an elevated surface?

  • Are the manufacturer’s load limit and warning stickers easy to read on each ladder?

  • Are metal ladders marked with easy-to-read signs cautioning against using them around electrical power sources?

  • Are rungs of ladders uniformly spaced at 12 inches, center to center?

Personal Protective Equipment

  • Is PPE used on-site?

  • Are approved safety glasses worn at all times in areas where there is a risk of eye injuries?

  • Are protective goggles or face shields provided and worn where there hazardous liquids, a danger of flying particles or corrosive materials?

  • Are hard hats provided and worn where danger of falling objects exists?

  • Is foot protection required as appropriate?

  • Is hand protection required as appropriate?

  • Is hearing protection required as appropriate?

Respiratory Protection

  • Are respirators used in the work area?

  • Is there a written respiratory protection procedure for the selection and use of respirators where needed?

  • Are respirator users trained annually and instructed in the correct usage and limitations of the respirators?

  • Are respirator users given annual fit tests?

  • Are respirators regularly inspected, cleaned, sanitized, and maintained?

  • Are respirators stored in a convenient, clean, and sanitary location?

  • Is voluntary respirator use governed through 1910.134 Appendix D?

  • If used more than 30 days per year, are respirator users given periodic medical evaluations to determine their ability to wear respirators?

Welding, Cutting, Brazing

  • Does Welding, cutting or brazing take place in the work area?

  • Are only authorized and trained personnel permitted to use welding, cutting, or brazing equipment?

  • Are hot-work permits required in areas not designed for regular hot work?

  • Are arc-welding cables intact with no damaged insulation or exposed conductors?

  • Are only approved apparatus (torches, regulators, pressure-reducing valves, acetylene generators, manifolds) used?

  • Is adequate ventilation in place where welding or cutting is conducted?

  • Is appropriate respiratory protection provided?

  • Is required PPE used properly and inspected periodically? Hoods, googles, gloves, aprons ... etc...

Compressors and Compressed Air

  • Are compressors or compressed air used in the work area?

  • Are all compressors equipped with pressure relief valves and pressure gauges?

  • Are compressor safety devices inspected annually?

  • Are all belt drive systems totally enclosed (guarded)?

  • Are compressed air nozzles either operated at 30 pounds per square inch (psi) system pressure or equipped with pressure-reducing tips that reduce the pressure to less than 30 psi?

  • Are compressed air receivers periodically drained of moisture and oil?

Compressed Gas Cylinders

  • Are compressed gas cylinders used in the work area?

  • Are cylinders legibly marked to clearly identify the gas contained?

  • Are valve protectors or caps always placed on cylinders and tightened when cylinders are not in use or connected for use?

  • Are cylinders stored or transported in a manner to prevent them from creating a hazard by slipping, falling, or rolling?

  • Are fuel gas and oxygen cylinders stored a minimum of 20 feet apart or separated by a one-hour firewall?

  • Are inspections dates current on cylinders?

Lockout Tagout

  • Are all employees trained to identify lock out (LOTO) system that maybe used by other employees even if they don't conduct LOTO them selves?

  • Is LOTO needed by workers in the work area?

  • Are all hazardous energy sources required to be de-energized, disengaged, blocked, or locked out during cleaning, servicing, adjusting, operations setup, or as required?

  • Are all lockout/tagout procedures performed by authorized employees?

  • Are authorized employees provided individually keyed safety locks?

  • Are equipment-specific lockout/tagout procedures in place for all machines or processes that involve multiple energy sources?

  • Is it required that only the authorized employee exposed to the hazard place or remove the safety lock?

  • Is an emergency lock-removal procedure in place?

  • Are means established to identify all authorized employees who are working on locked-out equipment by their locks or accompanying tags?

Confined Spaces

  • Are Confined Spaces located in the work area?

  • Are confined spaces identified?

  • Are confined spaces entered by employes?

  • Are confined space permits used when employees enter?

  • Is air testing conducted before and during entry?

  • Is meter calibration current?

  • Are rescuers or retrieval equipment ready for rapid use?

  • Team location and name

Flammable and Combustible Materials

  • Are Flammable or combustible materials used or stored in the work area?

  • Are approved containers and tanks used for the storage and handling of flammable and combustible liquids?

  • Are flammable liquids kept in closed containers when not in use?

  • Does paint spraying take place in this work area?

  • Does the paint spraying ventilation system minimum average air velocity of 100 fpm over the open face of the booth and explosion proof?

  • Is all wiring in painting and mixing area Class I, group D?

Hazardous chemicals exposure and Haz Comm

  • Is there a written Hazard Communication Program that meets the OSHA standard and addresses safety data sheets (SDSs), chemical container labeling, employee training, and other elements?

  • Are chemical present in the work area?

  • Are employees trained in Site Specific safe use of hazardous chemicals and materials?

  • Do employees use appropriate PPE and equipment to handle chemicals?

  • Are chemicals labeled ?

  • Are SDSs available for all chemicals in the work area?

  • Can Employees in the work area access the SDS's?

  • Is a master chemical list available for chemicals per 1910.1200?

  • Are employees trained on who to contact to report a chemical spill?

  • Are flammable and toxic chemicals kept in closed containers when not in use?

  • Are spills addressed with appropriate PPE, cleanup materials or containment?

  • Is Training provided to employees who address spills?

  • Are flammable and toxic chemicals kept in closed containers when not in use?

  • Are flammable and toxic chemicals kept in closed containers when not in use?

Electrical

  • Are there any open boxes or damaged electrical components in the work area?

  • Do employees use electrical tools?

  • Are electrical tools and equipment double-insulated or grounded?

  • Do all three wire cords have a ground prong?

  • Are extension cords or power stripes used in the work place?

  • Are extension cords permanently mounted, do they pass through doors, windows, rugs, ceiling or other openings?

  • Are power stripes "daisy chained" together?

  • Do employees conduct electrical repair?

  • Is work conducted in compliance with OSHA Standards and the National Electrical Code (NEC) by a certified electrian?

Noise

  • Are there areas in the workplace where continuous noise levels exceed 85 dBA?

  • Has this been documented through sound level meter readings or dosimetry?

  • Are reading documented and records kept?

  • Where are the records stored?

  • Is there an ongoing Hearing Conservation Program to monitor noise levels, provide audiometric testing, and educate employees in safe levels of noise exposures, effects of noise on their health, and the use of personal protective equipment?

Identification of Piping Systems

  • Are piping system that carry hazardous materials or compressed air marked?

  • Are lines heated?

  • When pipelines are heated by electricity, steam, or other external source, are suitable warning signs or tags placed at unions, valves, or other serviceable parts of the system?

Material Handling

  • Are Jack stands or other supporting equipment used in the work area?

  • Are they inspected annually?

  • Are slings, straps, chains or ropes used for lifting material?

  • Are the annually inspected?

  • Are Hoists or overhead cranes used in the work area?

  • Is the rated load of each hoist legibly marked and visible to the operator?

  • Are hooks with safety latches or other arrangements used when hoisting materials so that slings or load attachments will not accidentally slip off the hoist hooks?

  • Do hoists and overhead cranes receive annual inspections, and frequent inspections in writing?

  • Are stops provided at the safe limits of travel for hoists?

  • Are they tested daily?

  • Are shelves in the work area secured to prevent tipping or falling?

  • Are trucks and trailers secured from movement during loading and unloading operations?

  • Are industrial trucks used in the work area?

  • Are the operators in the work area trained every three years?

  • Are industrial trucks inspected in writing before each shift of use?

Hoists and Auxiliary Equipment

  • Does the work area utilize hoists, cranes, Jack stands or other lifting or supporting equipment?

  • Are the Hoists/Cranes inspected and certified Annually?

  • Are Hoist / Crane safety stops tested each day unit is used?

  • Are Jack Stands or other supporting equipment inspected annually

  • Is the rated load of each hoist legibly marked and visible to the operator?

  • Are operators trained oneach unit they operate?

Spraying Operations

  • Is Spraying conducted in the work Area?

  • Is adequate ventilation assured before spray operations are started?

  • Is mechanical ventilation provided when spraying operations are done within enclosed areas?

  • When mechanical ventilation is provided during spraying operations, does it properly vent contaminated air?

  • Is the spray area at least 20 feet from flames, sparks, operating electrical motors, and other ignition sources?

  • If sprayed product is flammable or combustibe, is all lighting equipment used class 1 division 1 rated?

  • Are spray booths constructed of metal, masonry, or other substantial, noncombustible material?

  • Are no-smoking signs posted in spray areas, paint rooms, paint booths, and paint storage areas?

  • Is approved respiratory equipment provided and used during spraying operations?

  • Are employees trained in use?

Hand Tools and Equipment

  • Are Jacks or jack stands used in the work area?

  • Are the inspected annually?

  • Are Hand Tools and Equipment used in the work area?

  • Are all tools and equipment maintained in good condition?

  • Are safety glasses, face shields, or other appropriate protective equipment used while using hand tools or equipment that might produce flying materials or be subject to breakage?

Portable Power Tools and Equipment

  • Are portable heaters used in the work area?

  • Are they designed to shut off if tipped over?

  • Are they located within 12 inches of combustable materials?

  • Are fans used in the work area?

  • Are fan blades protected with a guard having openings no larger than 1/2 inch, when operating within 7 feet of the floor?

  • Are Power tools used in the work area?

  • Are grinders, saws, and similar equipment provided with appropriate safety guards and are they used as recommended by the manufacturer?

  • Are portable electric tools and extension cords inspected regularly with the results documented?

  • Are rotating or moving parts of equipment guarded to prevent physical contact?

  • Are all cord-connected, electrically operated tools and equipment effectively grounded or of the approved double insulated type?

  • Are effective guards in place over belts, pulleys, chains, and sprockets?

  • Are provisions made to prevent machines from automatically starting when power is restored after a power failure or shutdown?

  • Is the power shut-off switch within reach of the operator’s position at each machine?

Abrasive Wheel Equipment - Grinders

  • Are Grinders or abrasive wheel equipment used in the work area?

  • Are work rests installed and kept adjusted to within 1/8 inch of the wheel?

  • Is the adjustable tongue on the top side of the grinder used and kept adjusted to within 1/4 inch of the wheel?

  • Do side guards cover the spindle, nut, and flange and 75 percent of the wheel diameter?

  • Are bench and pedestal grinders permanently mounted?

  • Are face shields and safety glasses worn when grinding?

  • Before new abrasive wheels are mounted, are they visually inspected and ring tested?

  • Is cleanliness maintained around grinders?

Power-Actuated Tools

  • Are Power-Actuated tools used in the work area?

  • Are employees who operate powder-actuated tools trained in their use, and do they carry a valid operator card?

  • Is each powder-actuated tool stored in its own locked container when not being used?

  • Do powder-actuated tool operators have and use appropriate personal protective equipment such as hard hats, safety goggles, safety shoes, and ear protection?

Machine Guarding

  • Are machines used in the work area that require guarding?

  • Are all moving chains, sprockets, power shafts, gears, and flywheels within 7 feet of the floor properly guarded?

  • Are methods provided to protect the operator and other employees in the machine areas from hazards created at the point of operation and from nip points, rotating parts, flying chips, and sparks?

  • Are machine guards secure and arranged so they do not pose a hazard when in use?

  • Are revolving drums, barrels, and containers guarded by an enclosure that is interlocked with the drive mechanism, so that they don’t revolve unless the guard enclosures are in place?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.