Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location
  • Participants:

1.0 General Worksite

  • 1.1 Safety signs / warnings posted where appropriate? 1910.145(c)(2)

  • 1.2 Emergency telephone numbers posted where they can be found readily?Emergency Action Plan

  • 1.3 Emergency evacuation / traffic routes identified and posted?

  • 1.4 Emergency evacuation routes are kept clear of debris and are easily accessible? 1910.37(a)(3)

  • 1.5 All work areas are clean and orderly? (best practice)

  • 1.6 Work areas are adequately illuminated? 1926.56

  • 1.7 Lights with bulbs that are not completely recessed are equipped with guards to prevent accidental contact with the bulb; 1915.82(b)(2)

  • 1.8 Aisles/stairs/floors clear; drips and spills cleaned up; trash cans empty and are free of food waste. (CFR 1926.25/ AK F&G)

2.0 Eyewash, Showers, Emergency Equipment

  • 2.0 Eyewash, Showers, Emergency Equipment

  • 2.1 Eyewash stations are inspected monthly and maintained monthly? ANSI Z35.8.1

  • 2.2 Eyewash stations are located in areas where exposure to caustic / acid is probable? 1910.151

  • 2.3 Eyewash stations are sanitary and if required fluids are treated within 6 month intervals? ANSI Z35.8.1

  • 2.4 Eyewash fluid is within expiration date and kept in sanitary condition? ANSI Z35.8.1

  • 2.5 Emergency shower fluids are tepid and suitable for use in the event of an emergency? ANSI Z35.8.1

  • 2.6 Access to eyewash stations and emergency showers is clear of obstruction? ANSI Z35.8.1

3.0 Fire Protection

  • 3.0 Fire Protection

  • 3.1 Fire suppression equipment inspection is current? 1910.160(b)(6)

  • 3.2 Fire alarms have been tested and are functioning correctly? 1910.160(b)6)

  • 3.3 Fire extinguishers are provided and readily accessible? 1910.157(c)(1)

  • 3.4 Fire extinguisher inspections are performed and current (monthly)? 1910.157(e)(1)(2)

4.0 Exit Routes

  • 4.1 Exit routes are clearly marked and illuminated by reliable light source? 1910.37

  • 4.2 All doors, passageways, or stairways that are not exits are marked as “Not an Exit”? 1910.37

  • 4.3 All Exit doors are clearly identified with appropriate signage of at least 5” letters? 1910.37

  • 4.4 All exits are free from obstruction? 1910.37

  • 4.5 Sufficient exits to permit prompt emergency escape? 1910.36

  • 4.6 Where panic hardware is installed the hardware functions easily in the direction of exit traffic? 1910.36

  • 4.7 Exterior door walkways are maintained to prevent ice/snow related falls; sand, nut-plug and shovel are readily available on site. (CFR 1910.211/1910.219)

  • 4.8 All exterior ingress and egress doorways are free of overhead ice/snow hazards. (CFR 1910.211/1910.219)

5.0 Walkways / Floor Openings

  • 5.1 Aisles and paths kept clean and clear? 1910.22(c)

  • 5.2 Wet surfaces are covered with non-slip material or are maintained by personnel? 1910.22(a)(2)

  • 5.3 Sumps / Floor openings are covered or guarded? 1910.23(c)(1)

  • 5.4 Toe boards are installed around edges of permanent floor openings? 1910.23(c)(1)

  • 5.5 Grates and floor covers designed so that foot traffic / rolling equipment will not affect their placement? 1910.22(d)(1)

6.0 Stairways / Elevated Work Surfaces

  • 6.1 Stairs equipped with standard railings with four or more stair risers? 1910.28(b)(ii)

  • 6.2 Stairways at least 22” wide? 1910.25(c)(4)(i)

  • 6.3 Stair risers are uniform from top to bottom and no more than 7.5” tall? 1910.25(b)(3)

  • 6.4 Steps are designed to be a slip resistant surface? - Best Practice

  • 6.5 Handrails located between 30” and 34” of the surface of the stair treads? 1910.28

  • 6.6 Handrails capable of withstanding 200# of force when applied within 2” of the top rail edge? 1910.28

  • 6.7 Signs posted showing the surface load capacity? 1910.176(b)

  • 6.8 Surfaces elevated more than 48” have standard guardrails provided? 1910.28(b)1(i)

  • 6.9 Elevated surfaces that expose workers or machinery to falling objects protected with 4” toe boards? 1910.28(b)(1)(i)

  • 6.10 Permanent means of access and egress provided to elevated work surfaces? 1910.22(c)

7.0 Ladders

  • 7.1 Ladders inspected and maintained in good condition? 1910.23

  • 7.2 Non-slip feet provided on each ladder? 1910.23

  • 7.3 Ladder rungs and steps free from grease and oil? 1910.23

  • 7.4 Ladders with missing steps or cleats, broken side rails, or faulty equipment are removed from service? 1910.23

  • 7.5 Extension ladders are appropriately set up extending 3 feet above the surface being accessed? 1910.23

  • 7.6 Ladders are clearly marked with caution signs and load limits? 1910.23

  • 7.7 Ladder rungs are uniformly spaced at 12” center to center? 1910.23

8.0 Flammable and Combustible Storage

  • 8.1 Approved containers used for the storage and handling of flammable and combustible liquids? 1910.106(a)(32)

  • 8.2 Flammable liquids kept in closed containers when not in use? 1910.106(d)(5)

  • 8.3 Flammable liquids are dispensed from bulk containers using bonding or grounding straps? - ASH

  • 8.4 Flammable and combustibles are placed in approved flammable storage cabinets when not in use? 1910.106(d)(5)iii

  • 8.5 Flammable storage cabinets are kept closed and latching mechanisms function properly? 1910.106(d)(5)i-v

  • 8.6 Combustible materials are not placed on the top of flammable storage cabinets? - NFPA 30

9.0 Hazardous Material Storage

  • 9.1 All containers or tanks with recyclable hydrocarbons are labeled as “Used Oil.” (40 CFR 279)

  • 9.2 Oily waste properly bagged. No chemicals are mixed in oily waste bags. (40 CFR 262)

  • 9.3 SAA containers labeled hazardous waste and kept closed. (40 CFR 262)

  • 9.4 All hazardous materials are labeled and MSDS is available

  • 9.5 Battery room doors closed and ventilation system operating (CFR 1926.441)

  • 9.6 Battery room has required PPE readily available, including eye wash capabilities (CFR 1926.441)

10. Material Handling / Hoisting and Auxiliary Equipment

  • 10.1 Safe clearance for equipment through aisles and doorways? 1910.176

  • 10.2 Mechanized equipment inspected daily prior to use? 1910.178

  • 10.3 Hooks are equipped with safety latches and are in good condition? 1926.251

  • 10.4 All rigging and lifting equipment has been inspected annually and are color coded to reflect current year of inspection? 1926.251

  • 10.5 Stacked materials are interlaced to prevent sliding or tipping? 1926.250

  • 10.6 Shelves and pallet racks are secured from tipping or falling? 1926.250

  • 10.7 Maximum load limits posted on shelving and rack systems? 1926.250

  • 10.8 Electrical hoists are equipped with functioning limit devices at highest and lowest point? 1926.554

  • 10.9 Rated load of hoist is legibly marked and visible to the operator? 1926.554

  • 10.10 Controls for hoists are plainly marked to indicate the direction of travel or motion? 1910.179

  • 10.11 Hoist Inspection Certifications are maintained on site? 1926.179

11.0 Process Equipment

  • 11.1 Pressure Equipment: Bull plugs installed, valves properly positioned, proper utility fittings in place

  • 11.2 All required PSVs are in service; valve handles locked and car-seals in place. (CFR 1910.147)

  • 11.3 Adequate supply of various lock out tag out devices on hand and available for use. (CFR 1910.147)

  • 11.4 Hazard warning flagging used correctly and not used for energy isolation (CFR 1910.147)

  • 11.5 Hoses and fittings: Correct application (service/pressure), signs of damage (hose, fitting, clamping device), whip-checks in use, working pressure noted on hose. (CFR 1926.302)

  • 11.6 All fired equipment positioned such that the exhaust doesn’t enter air/fan intakes. (CFR 1910.6 )

  • 11.7 Spill/leak containment drip pans in place and maintained where needed

  • 11.8 Ground straps in use for Flammable Liquid Storage & Transfer; approved containers used and labeled; containers provided with self-closing valve; drums/container/vessels labeled (NFPA 704M label) where required

  • 11.9 Emergency stops and critical electrical controls are identified

12.0 Machine Guarding

  • 12.1 Is sufficient clearance provided around and between machines to allow for safe operation?

  • 12.2 Is equipment and machinery securely placed and anchored when necessary to prevent tipping?

  • 12.3 Is power shut off switch in the reach of the operator’s position at the machine?

  • 12.4 Are all emergency stop buttons brightly colored and or placarded?

  • 12.5 Pulleys and belts within 7 feet of the floor or working level are properly guarded?

  • 12.6 Chains and gears properly guarded?

  • 12.7 Is the grinder effectively grounded?

  • 12.8 Is cleanliness maintained within the vicinity of the grinder?

13.0 Abrasive Wheel Equipment

  • 13.1 Are work rests installed and kept adjusted to within 1/8” of the wheel? 1926.303

  • 13.2 Is the adjustable tongue guard used and kept adjusted to within ¼” of the wheel? 1926.303

  • 13.3 Do side guards cover the spindle, nut, and flange, and 75% of the wheel diameter? 1926.303

  • 13.4 Are bench and pedestal grinders permanently mounted? 1910.212

  • 13.5 Maximum RPM consistent between abrasive wheel and grinder motor? 1910.251

14.0 Compressors / Compressed Air Equipment

  • 14.1 Compressors are equipped with pressure relief valves and pressure gauges? 1910.169(b)(3)i

  • 14.2 Signs posted warning employees of the automatic starting features if equipped? 1910.145(c)(2)

  • 14.3 All moving parts/belt systems are adequately guarded to prevent injury to personnel? 1910.213(a)

  • 14.4 Air nozzles are designed to reduce airflow to 30psi? 1910.242

  • 14.5 Airlines are attached using whip checks? 1926.302(b)(1)

  • 14.6 Compressed air is not being used or directed at personnel in the area? 1910.242

15.0 Compressed Gas Cylinders

  • 15.1 Cylinders are legibly marked to clearly identify the gas contained? NFPA 63.3.2

  • 15.2 Cylinders are stored in areas that are protected from external heat sources? NFPA 63.3.2

  • 15.3 Cylinders stored in appropriate carts or racks which prevent them from tipping or falling? 1926.350

  • 15.4 Valve protector caps installed on cylinders when not in use? 1926.350

  • 15.5 Cylinders stored at least 20’ away from combustible materials? 1926.350

  • 15.6 Fuel gas and oxygen cylinders are stored a minimum of 20’ apart or separated by a 1-hour fire wall? 1926.350

  • 15.7 Cylinders are free of visible deterioration and maintained with current hydro inspection dates? NFPA 55

16.0 Electrical

  • 16.1 Extension cords in use are in good condition and have a grounding conductor? 1910.304

  • 16.2 GFCIs are installed on AC circuits where construction, demolition, modifications, alterations, or excavations are performed? 1910.304

  • 16.3 Electrical wiring and cords are in good condition without deteriorated insulation, exposed wire, or frays? 1910.303

  • 16.4 Electrical cords and cables free of splices and taps? 1910.303

  • 16.5 Cord, cable, and raceway connections are intact and secure? 1910.303

  • 16.6 Disconnecting switches and service breakers are clearly labeled to indicate their use or equipment served? 1910.303

  • 16.7 Sufficient access and working space provided and maintained around all electrical equipment to permit safe operation and maintenance? NEC 2017

  • 16.8 Unused opening including conduit knockouts in electrical enclosures and fittings protected with appropriate covers, plugs, or plates? 1910.303

  • 16.9 Switches, receptacles, junction boxes, etc., provided with tight fitting covers or plates? 1910.303

  • 16.10 Electrical equipment is clearly marked or labeled with appropriate warnings? 1910.303

  • 16.11 Temporary wiring is not used in a permanent location? 1910.304

  • 16.12 Electrical Panels: are marked, have clear access, and outlets, switches, and boxes are covered. 1910.303

17.0 Hand Tools & Power Tools

  • 17.1 Tools and equipment maintained in good condition? 1926.300

  • 17.2 Hand tools such as chisels, punches, etc. which develop mushroomed heads reconditioned or replaced? 1926.301

  • 17.3 Broken handles on hammers, axes and similar equipment removed from service and replaced? 1926.301

  • 17.4 Worn or bent wrenches are removed from service replaced? 1926.301

  • 17.5 Jacks inspected periodically and weight limits posted on the equipment? 1926.305

  • 17.6 Tools stored in dry, secure location? 1926.300

  • 17.7 Are guards installed on grinders, saws, and other similar equipment? 1926.301

  • 17.8 Power tools appropriately grounded with grounding pin or of the approved double insulated type? 1926.302

  • 17.9 Effective guards in place over belts, pulleys, chains, and sprockets? 1926.301

  • 17.10 Pneumatic and hydraulic hoses on power operated tools in good condition with no sign of damage or deterioration? 1926.300

  • 17.11 Bench and free standing tools are appropriately secured to work benches or floors? 1910.212

  • 17.12 Electrical tools are connected directly to receptacle without the use of an extension cord when in permanent location? 1910.304

18.0 Additional Findings

  • Additional Findings:

  • Person Responsible for Ensuring Correction of all noted deficiencies:

  • Due Date:

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.