General Workplace Safety Observation & Review

Title Page

Safety / Grass Roots Team / Leader
Conducted on (Date and Time)
Safety Observation(s)

Section 1 - Access / General

1.1 Are walkways, aisles, and working surfaces free of slip hazards (such as oil, grease, water, ink)?
1.2 Are walkways, aisles, working surfaces, exits, and doors free of obstructions (such as boxes, equipment, materials, or tools)?
1.3 Are traffic devices (such as a mirror, strobe light, or traffic cones) available for congested areas?
1.4 Are pedestrian traffic signs and markings easy to see?
1.5 Are there any blown lights in the work area?
1.6 Are Exit routes clearly marked “Exit,” and show the direction of travel to an Exit?
1.7 Are hoses and electrical cords positioned out of walk-ways to prevent injury to workers?
1.8 Are employees familiar with emergency location and planning such as Shelter in Place or Assembly Points?
1.9 Has housekeeping been performed in work areas?
1.10 Are there any additional hazards? If yes, take a picture and communicate it to Supervisor.
1.11 Nominal Score = 3 Points, 5 Points = Max Score

Section 2.0 - Fire Prevention / First Aid / Eye Wash Station(s)

2.1 Are fire extinguishers within 50 feet of work areas?
2.2 Has each fire extinguisher been inspected and tagged for the month?
2.3 Are oily rags stored in a metal container with a closed lid?
2.4 Are employees familar with the AED location?
2.5 Has the AED been checked for use?
2.6 Have emergency Eye Wash Stations been inspected and checked each month?
2.7 Are employee familiar with the First Aid Kit location?
2.8 Are flammable and combustible materials stored as required by regulatory standards?
2.9 Are there any additional hazards? If yes, take a picture and communicate it to Supervisor.
2.10 Nominal Score = 3 Points, 5 Points = Max Score

Section 3 - Guarding

3.1 Are barriers in place to keep un-authorized employees and visitors away from heavy machinery and materials?
3.2 Are machine guards in place to protect workers?
3.3 Are there machine guards that appear to broken, loose, or in need of repair?
3.4 Is the YELLOW Energy Safe Task Tag visible and available for use as the alternative to LOTO for clearing a jam and servicing?
3.5 Is the LOTO program available for review for the operator?
3.6 Are EST Tools within the immediate work area?
3.7 Have employees been issued their own lock?
3.8 Have employees completed LOTO training?
3.9 Are there any defective interlock(s) or safety switches that should be reported?
3.10 Are there any additional hazards? If yes, take a picture and communicate it to Supervisor.
3.11 Nominal Score = 20 Points, 25 Points = Max Score

Section 4 - Fall Protection

4.1 Are ladders, step-ladders, or stools serviceable (do not require repairs or removal)?
4.2 Are serviceable ladders, step-ladders, or stools stored and secured in specific locations?
4.3 Have ladders, step-ladders, and tools been tagged and inspected for Safe Use?
4.4 Have holes (larger than 2 inches) on walking or working surfaces been covered and will support twice the intended load?
4.5 Are guard rails serviceable at all working levels?
4.6 Have any guard rails been damaged or may be missing at any level?
4.7 Have employees received training for any work that may be performed 4 feet above another working surface or level?
4.8 Have employees received training for any specialty equipment (such as scissor or boom lift)?
4.9 Has an inspection been performed on mobile elevated work platforms (aerial lifts)?
4.10 Have cones, barricades, warning line, and signs been erected for overhead work protection?
4.11 Are mezzanine(s) and work platform(s) safe for access and work?
4.12 Are drip pans and guards in place to catch spills?
4.13 Are there any additional hazards? If yes, take a picture and communicate it to Supervisor.
4.14 Nominal Score = 8 Points, 10 Points = Max Score

Section 5.0 - Electrical

5.1 Have electrical cords been inspected for the month?
5.2 Are ground fault interrupt or ground fault circuit interrupt in serviceable condition?
5.3 Are ground pins available on extension cords?
5.4 Are extension cords being used as temporary ONLY?
5.5 Has the machine / equipment been locked and tagged out for maintenance and repairs?
5.6 Are Lockout / Tagout procedures available or posted on the machine or equipment?
5.7 Is the Energy Safety Task procedure used for routine, cleaning, jams, and repetitive task(s)?
5.8 Has the Exclusive Person or Operator been identified if the Energy Safe Task Procedure is used?
5.9 Are the controls for the equipment or machine under control of the Exclusive Person?
5.10 Has the EST decision tree been used and are hand tools available?
5.11 Is the EST Yellow Tag visible on controls?
5.12 Are electrical panels and doors closed and secured?
5.13 Are there any electrical panels, doors, or cases that have been damaged?
5.14 Are there any electrical panels or circuits that show signs of wear (to include exposed wiring)?
5.15 Are post in front of electrical panels and boxes free of damage?
5.16 Are there any additional hazards? If yes, take a picture and communicate it to Supervisor.
5.17 Nominal Score = 16 Points, 20 Points = Max Score

Section 6.0 - Forklift / Material Handling / Storage / Dock(s)

6.1 Have forklifts been inspected prior to shift change?
6.2 Have 3rd party vendors made maintenance records available?
6.3 Have forklift operators completed training?
6.4 Have crane operators completed training?
6.5 Have crane operators inspecting hoisting equipment (such as slings and connectors)?
6.6 Are crane records available for review?
6.7 Are signs, cones, barricades, or spotters used for overhead work activities?
6.8 Are crane operators, signal persons, and riggers identified with HI-VIZ PPE?
6.9 Are materials stored in the designated areas to prevent falls?
6.10 Has a RED CARD been completed for OVERHEAD WORK for EACH SHIFT?
6.11 Are operators wearing Seat Belts?
6.12 Are dock locks serviceable and free of damage?
6.13 Are wheels chocked for loading and unloading materials, equipment, or machines?
6.14 Are there any additional hazards? If yes, take a picture and communicate it to Supervisor.
6.15 Nominal Score = 12 Points, 15 Points = Max Score

Section 7.0 - PPE

7.1 Are employees wearing and using Eye Protection?
7.2 Are employees wearing and using Hearing Protection?
7.3 Are employees wearing and using Hand / Sleeve Protection?
7.4 Are employees wearing hard toe work shoes or boots?
7.5 Are there any additional hazards? If yes, take a picture and communicate it to Supervisor.
7.8 Nominal Score = 3 Points, 5 Points = Max Score

Section 8.0 - Chemical Storage

8.1 Are non-hazardous and hazardous chemicals labeled (including secondary containers)?
8.2 Are waste drum(s) labeled and dated?
8.3 Are acids, bases, flammables, and oxidizers separated (including gas cylinders) more than 20 feet?
8.4 Are Compressed Gas Cylinders stored, secured and separated 20 feet or more?
8.5 Are rag bin(s) serviceable and closed?
8.6 Are drum lids closed and secured?
8.7 Are drums free of damage and wear (including leaks)?
8.8 Are bung(s) secured to the drum?
8.9 Are fire lockers free of damage (including rust, broken latches, equipment dents)?
8.10 Have contents in Fire Lockers been inspected each month?
8.11 Are spill kits located within chemical storage areas?
8.12 Has spill kits been inventoried or replenished?
8.14 If used for cleaning, has compressed air lines or nozzle(s) been modified to 30 psi or less?
8.15 Is Universal Waste labeled?
8.16 Are chemical(s) stored need Energy Sources (such as Electrical)?
8.17 Are metal container(s) or drums storing flammable liquids (bonded) from electrical shock?
8.18 Are there any additional hazards? If yes, take a picture and communicate it to Supervisor.
8.19 Nominal Score = 8 Points, 10 Points = Max Score

Section 9.0 - Tool(s) / Equipment

9.1 Is equipment or tooling inspected prior to use?
9.2 Is a copy of the inspection log available?
9.3 Are grinder guards adjusted to 1/4" from wheel?
9.4 Is the grinder work rest within 1/8" of the wheel?
9.5 Have tools been returned to the cabinet, bin, pouch, or other storage location after use?
9.6 Are there any tools that are defective and should be removed from use?
9.7 Are there any additional hazards? If yes, take a picture and communicate it to Supervisor.
9.8 Nominal Score = 3 Points, 5 Points = Max Score