Indy Equipment Shops

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Ladders/Stairs

• Is ladder free of defects?

  Yes

  No

  N/A

• Is ladder being used properly?

  Yes

  No

  N/A

• Yes

  No

  N/A

• Is ladder secured?

  Yes

  No

  N/A

• Is extension ladder used on 4:1 pitch?

  Yes

  No

  N/A

• Does ladder extend 3' or more above landing?

  Yes

  No

  N/A

• Is ladder a safe work distance from hazard?

  Yes

  No

  N/A

• Have slip/trip exposures on ladder been eliminated?

  Yes

  No

  N/A

• Are access/egress areas free of debris/materials?

  Yes

  No

  N/A

Motorized Equipment

• Is operator working safely?

  Yes

  No

  N/A

• Is machine operating at least 10' away from overhead power lines?

  Yes

  No

  N/A

• Is proper operator protection in place (ROPS, cage, screen, etc.)?

  Yes

  No

  N/A

• Are seat belts being used?

  Yes

  No

  N/A

• Does backup alarm function properly?

  Yes

  No

  N/A

• If fire extinguisher present with current inspection?

  Yes

  No

  N/A

• Does horn function properly?

  Yes

  No

  N/A

• Is weekly equipment inspection form completed?

  Yes

  No

  N/A

Electrical

• Is electrical equipment properly grounded?

  Yes

  No

  N/A

• Are GFCI's being utilized?

  Yes

  No

  N/A

• Are appropriate cords being used and in good condition?

  Yes

  No

  N/A

• Are cords protected from traffic?

  Yes

  No

  N/A

• Are energized parts and equipment protected??

  Yes

  No

  N/A

Hand and Power Tools

• Proper tool for the job?

  Yes

  No

  N/A

• Tool in good condition? Guards in Place? Label on tool?

  Yes

  No

  N/A

• Proper PPE?

  Yes

  No

  N/A

Manual Material Handling

• Proper lifting technique?

  Yes

  No

  N/A

• No manual lift over 50 lbs.?

  Yes

  No

  N/A

• Lifts over 50 lbs. get aid or assistance?

  Yes

  No

  N/A

• Use of mechanical aid? (If applicable)

  Yes

  No

  N/A

• Clear and planned path?

  Yes

  No

  N/A

PPE

• Safety Glasses

  Yes

  No

  N/A

• Gloves

  Yes

  No

  N/A

• Boots

  Yes

  No

  N/A

• Hi-Vis

  Yes

  No

  N/A

Fire Extinguishers

• Extinguishers charged and inspections current?<br>**Comment with Month and Year of Expiration

  Yes

  No

  N/A

Housekeeping

• Is access/egress hazard free?

  Yes

  No

  N/A

• Are sanitary facilities available, adequate, and clean?

  Yes

  No

  N/A

• Are slip, trip and fall hazards present around work areas?

  Yes

  No

  N/A

• Is material storage adequate and utilized properly?

  Yes

  No

  N/A

• Is trash collected in protected containers?

  Yes

  No

  N/A

Medical Emergency

• Is there an individual certified in first aid/CPR onsite?

  Yes

  No

  N/A

• First Aid Kit?

  Yes

  No

  N/A

• Eyewash?

  Yes

  No

  N/A

• Emergency numbers/plans posted?

  Yes

  No

  N/A

SDS/HAZCOM

• Site Specific SDS?

  Yes

  No

  N/A

• Containers properly labelled and inventory listed?

  Yes

  No

  N/A