Internal Safety Audit 875e

• Store Number

• Store Manager Name

• Conducted on

  Date

• Audit Prepared by

• Location
  Address

• Begin audit by checking in at the Customer Service desk or with Store Manager.

Safety Files and Training Documentation

• Are all Safety files up to date and filed in logical order? <br>

  Yes

  No

  N/A

• Review the OSHA 300 logs for injuries this year and last year. Are the managers accurately recording the injuries on the log?<br>

  Yes

  No

  N/A

• How many injuries are recorded on the OSHA 300 log?

• Review the injury investigation file. Is the manager conducting adequate injury investigations and providing corrective actions?

  Yes

  No

  N/A

• Review the Safety Employee Warning Notice file. How many warning notices for safety violations have been issued for this year?

• Is the Blood Borne Pathogen Authorized user list up to date with the most current managers listed?

  Yes

  No

  N/A

• Is there a copy of the Blood Borne Pathogen knowledge test on file for each authorized manager? If no, list missing names or other discrepancies.<br>

  Yes

  No

  N/A

• Review the Lock Out Tag Out authorized user list. Is there a copy of the knowledge test on file for each authorized associate? If no, list missing names or other discrepancies.

  Yes

  No

  N/A

• Has the Lock Out Tag Out annual review been conducted for all authorized employees?<br>

  Yes

  No

  N/A

• Are SDS (Safety Data Sheets, formerly known as MSDS) on file for all chemicals used in the facility? If no, make note of any deficiencies.<br>

  Yes

  No

  N/A

• Is the Safety Data Sheet available for Lead Acid Batteries?

  Yes

  No

  N/A

Courtesy Booth

• Have Courtesy Booth employees received training as to what to do in case of robbery? Verify documentation.

  Yes

  No

  N/A

• Is the floor free of debris or excess liquids (slip/trip hazards)?

  Yes

  No

  N/A

• Are anti-fatigue mats provided for the Courtesy Booth employees?

  Yes

  No

  N/A

• Are the Lock Out Tag Out log sheets up to date with correct information being recorded on them?

  Yes

  No

  N/A

• Review Lock Out Tag Out devices. Do they appear to be in proper working order?

  Yes

  No

  N/A

• Is the department free of obvious electrical hazards including, but not limited to electrical panels, missing or improper labeling, frayed wires, missing ground plugs, broken light switches, etc.?

  Yes

  No

  N/A

• Are electrical panels free of obstructions?

  Yes

  No

  N/A

• Are first aid kits stocked with at least minimum required items?

  Yes

  No

  N/A

Check Out Area

• Are employees that are working outside wearing the provided ANSI Class II reflective vests?

  Yes

  No

  N/A

• Are exits/emergency exits free from obstructions?

  Yes

  No

  N/A

• Are the floors free of any apparent slip/trip hazards? If no, describe.

  Yes

  No

  N/A

• Are cashiers using proper technique to scan items? They should be using the reach and feed method of picking up the item with one hand, passing it over the scanner to the other hand and placing the item on the register belt.

  Yes

  No

  N/A

• Are anti-fatigue mats provided for the Cashiers?

  Yes

  No

  N/A

• Are chemicals used in the department contained in properly labeled bottles?

  Yes

  No

  N/A

• Is the department adhering to the policy of not removing chemicals from the shelves?

  Yes

  No

  N/A

• Is the department free of obvious electrical hazards including, but not limited to electrical panels, missing or improper labeling, frayed wires, missing ground plugs, broken light switches, etc.?

  Yes

  No

  N/A

• Are electrical panels free of obstructions?

  Yes

  No

  N/A

• Additional Comments or corrective actions.

Interview 1 Non-Manager Employee from the Check Out Area or Courtesy Booth

• Name of interviewed employee

• Do you have any concerns in regards to safety that you feel we need to address?

  yes

  no

• What are your concerns?

• Have you spoken to a manager about these concerns?

  yes

  no

• Were these concerns that you raised properly addressed by your manager?

  Yes

  No

  N/A

• Have you received any of the following training? Check box if training was received.

• Chemical training? The employee should know what Safety Data Sheets are, that there is first aid information on them, where the eyewash station is and how to use it, and how to read labels on chemical bottles.

• Emergency Evacuation training?

• Compactor use, if over 18?

• Has the employee received any other safety related training? If yes, please list additional training.

  yes

  no

• Does the employee seem knowledgeable in regards to his/her training?<br>

  Yes

  No

  N/A

• If there was a small amount of blood spilled on the floor, would you clean it up?

  yes

  no

• What would you do? Note answer. Answer should be inform a manager.

• Inform the employee that they are not authorized to clean up blood and that they must inform a manager if they encounter a blood spill or any other accident.

Grocery Department

• Are the sales floor and back room area free of debris and excess liquids (slip/trip hazards)?

  Yes

  No

  N/A

• Are display media, shelving, racks, etc. in proper repair as to not cause injury to an employee? Look for broken parts, loose shelving, protruding objects, frayed wires, etc. If no, explain.

  Yes

  No

  N/A

• Are items on shelving stacked properly and items stored on pallets in racking shrink wrapped properly so as to not fall on employees?

  Yes

  No

  N/A

• Are gigs and pallets in proper working condition?

  Yes

  No

  N/A

• Does Powered Industrial Equipment appear to be in proper working condition including having warning labels and data plate intacts?

  Yes

  No

  N/A

• Are dock plates stored securely when not in use?

  Yes

  No

  N/A

• Are chemicals used in the department contained in properly labeled bottles?

  Yes

  No

  N/A

• Is the department adhering to the policy of not removing chemicals from the shelves?

  Yes

  No

  N/A

• Interview the employee responsible (only assistant store managers are authorized) for filling the water in the batteries of both PIE and the floor equipment. Can they explain the process for filling the batteries? They should be able to explain that they wear chemical gloves and splash googles. They should also be using the battery filling container and they must fill the batteries near the eyewash station.

  Yes

  No

  N/A

• Is the department free of obvious electrical hazards including, but not limited to electrical panels, missing or improper labeling, frayed wires, missing ground plugs, broken light switches, etc.?

  Yes

  No

  N/A

• Are electrical panels free of obstructions?

  Yes

  No

  N/A

• Are safety signs and labels in place and intact? Look at the powered industrial equipment. This includes minimum age usage signs, warning labels, exit signs, etc. Please note any deficiencies.

  Yes

  No

  N/A

• Additional Comments or corrective actions.

Interview 1 Non-Manager Employee from the Grocery Department.

• Name of interviewed employee

• Do you have any concerns in regards to safety that you feel we need to address?

  yes

  no

• What are your concerns?

• Have you spoken to a manager about these concerns?

  yes

  no

• Were these concerns that you raised properly addressed by your manager?

  Yes

  No

  N/A

• Have you received any of the following training? Check box if training was received.

• Chemical training? The employee should know what Safety Data Sheets are, that there is first aid information on them, where the eyewash station is and how to use it, and how to read labels on chemical bottles.

• Emergency Evacuation training?

• Compactor use, if over 18?

• Lock Out Tag Out trained?

  yes

  no

• Have employee describe LOTO procedure. Can they go through all the steps properly including mentioning that they test for power?

  Yes

  No

  N/A

• Powered Industrial Equipment trained?

  yes

  no

• Have employee describe the training that they received and how long the session was. Does the employee appear competent to use the equipment? Some items they should be able to discuss are stability triangle and weight capacity.

  Yes

  No

  N/A

• Has the employee received any other safety related training? If yes, please list additional training.

  yes

  no

• Does the employee seem knowledgeable in regards to his/her training?<br>

  Yes

  No

  N/A

• If there was a small amount spilled on the floor, would you clean it up?

  yes

  no

• What would you do? Note answer. Answer should be inform a manager.

• Inform the employee that they are not authorized to clean up blood and that they must inform a manager if they encounter a blood spill or any other accident.

Dairy Department

• Is the cooler and back room area free of debris and excess liquids (slip/trip hazards)?

  Yes

  No

  N/A

• Are latches on cooler or freezer doors in proper working order so as to prevent entrapment?<br>

  Yes

  No

  N/A

• Is there any excess ice buildup in any of the freezers either on the ceiling or the floor, including around doorways and the threshold?

  yes

  no

• Are display cases, racks, spot coolers, etc. are in in proper repair as to not cause injury to an employee? Look for broken parts, loose shelving, protruding objects, frayed wires, etc. If no, explain.

  Yes

  No

  N/A

• Are chemicals used in the department contained in properly labeled bottles?

  Yes

  No

  N/A

• Is the department adhering to the policy of not removing chemicals from the shelves?

  Yes

  No

  N/A

• Are items stacked properly on shelving so as to not fall on employees, while also maintaining an 18 inch plane of clearance around room from sprinkler heads?

  Yes

  No

  N/A

• Is the department free of obvious electrical hazards including, but not limited to electrical panels, missing or improper labeling, frayed wires, missing ground plugs, broken light switches, etc.?

  Yes

  No

  N/A

• Are electrical panels free of obstructions?

  Yes

  No

  N/A

• Additional Comments or corrective actions.

Interview 1 Non-Manager Employee from the Dairy Department.

• Name of interviewed employee

• Do you have any concerns in regards to safety that you feel we need to address?

  yes

  no

• What are your concerns?

• Have you spoken to a manager about these concerns?

  yes

  no

• Were these concerns that you raised properly addressed by your manager?

  Yes

  No

  N/A

• Have you received any of the following training? Check box if training was received.

• Chemical training? The employee should know what Safety Data Sheets are, that there is first aid information on them, where the eyewash station is and how to use it, and how to read labels on chemical bottles.

• Emergency Evacuation training?

• Compactor use, if over 18?

• Lock Out Tag Out trained?

  yes

  no

• Have employee describe LOTO procedure. Can they go through all the steps properly including mentioning that they test for power?

  Yes

  No

  N/A

• Powered Industrial Equipment trained?

  yes

  no

• Have employee describe the training that they received and how long the session was. Does the employee appear competent to use the equipment? Some items they should be able to discuss are stability triangle and weight capacity.

  Yes

  No

  N/A

• Has the employee received any other safety related training? If yes, please list additional training.

  yes

  no

• Does the employee seem knowledgeable in regards to his/her training?<br>

  Yes

  No

  N/A

• If there was a small amount of blood spilled on the floor, would you clean it up?

  yes

  no

• What would you do? Note answer. Answer should be inform a manager.

• Inform the employee that they are not authorized to clean up blood and that they must inform a manager if they encounter a blood spill or any other accident.

Deli Department

• Is the cooler and back room area free of debris and excess liquids (slip/trip hazards)?

  Yes

  No

  N/A

• Are latches on cooler or freezer doors in proper working order so as to prevent entrapment?<br>

  Yes

  No

  N/A

• Are display cases, racks, spot coolers, etc. are in in proper repair as to not cause injury to an employee? Look for broken parts, loose shelving, protruding objects, frayed wires, etc. If no, explain.

  Yes

  No

  N/A

• Are chemicals used in the department contained in properly labeled bottles?

  Yes

  No

  N/A

• Are chemicals being stored properly in the department (they should never stored above food)?<br>

  Yes

  No

  N/A

• Is the department adhering to the policy of not removing chemicals from the shelves?

  Yes

  No

  N/A

• Are items stacked properly on shelving so as to not fall on employees, while also maintaining an 18 inch plane of clearance around room from sprinkler heads?

  Yes

  No

  N/A

• Are all knives being stored properly when not in use? Look for unattended knives at various work stations.

  Yes

  No

  N/A

• Are employees closing the deli slicer blade prior to removing product from the slicer and also when not in use?

  Yes

  No

  N/A

• Are first aid kits stocked with at least minimum required items?

  Yes

  No

  N/A

• Is the department free of obvious electrical hazards including, but not limited to electrical panels, missing or improper labeling, frayed wires, missing ground plugs, broken light switches, etc.?

  Yes

  No

  N/A

• Are electrical panels free of obstructions?

  Yes

  No

  N/A

• Are safety signs and labels in place and intact? This includes minimum age usage signs, warning labels, exit signs, etc. Please note any deficiencies.

  Yes

  No

  N/A

• Additional Comments or corrective actions.

Interview 1 Non-Manager Employee from the Deli Department.

• Name of interviewed employee

• Do you have any concerns in regards to safety that you feel we need to address?

  yes

  no

• What are your concerns?

• Have you spoken to a manager about these concerns?

  yes

  no

• Were these concerns that you raised properly addressed by your manager?

  Yes

  No

  N/A

• Have you received any of the following training? Check box if training was received.

• Chemical training? The employee should know what Safety Data Sheets are, that there is first aid information on them, where the eyewash station is and how to use it, and how to read labels on chemical bottles.

• Emergency Evacuation training?

• Compactor use, if over 18?

• Knife training?

• Have the employee explain the important training points regarding knife use. Does the employee display good knowledge? The employee should be able to explain the use of a cut resistant glove, to never leave a knife laying out unattended, and also how to clean the knife properly.

  Yes

  No

  N/A

• Have the employee explain how to break down and clean the deli slicer. Can the employee describe the steps, including the use of cut resistant gloves on both hands to clean he blade?

  Yes

  No

  N/A

• Lock Out Tag Out trained?

  yes

  no

• Have employee describe LOTO procedure. Can they go through all the steps properly including mentioning that they test for power?

  Yes

  No

  N/A

• Powered Industrial Equipment trained?

  yes

  no

• Have employee describe the training that they received and how long the session was. Does the employee appear competent to use the equipment? Some items they should be able to discuss are stability triangle and weight capacity.

  Yes

  No

  N/A

• Has the employee received any other safety related training? If yes, please list additional training.

  yes

  no

• Does the employee seem knowledgeable in regards to his/her training?<br>

  Yes

  No

  N/A

• If there was a small amount of blood spilled on the floor, would you clean it up?

  yes

  no

• What would you do? Note answer. Answer should be inform a manager.

• Inform the employee that they are not authorized to clean up blood and that they must inform a manager if they encounter a blood spill or any other accident.

Meat Department

• Is the cooler and back room area free of debris and excess liquids (slip/trip hazards)?

  Yes

  No

  N/A

• Are latches on cooler or freezer doors in proper working order so as to prevent entrapment?<br>

  Yes

  No

  N/A

• Is there any excess ice buildup in any of the freezers either on the ceiling or the floor, including around doorways and the threshold?

  yes

  no

• Are display cases, racks, spot coolers, etc. are in in proper repair as to not cause injury to an employee? Look for broken parts, loose shelving, protruding objects, frayed wires, etc. If no, explain.

  Yes

  No

  N/A

• Is the band saw in operation at the time of the audit?

  yes

  no

• Is the band saw being operated properly, including using provided guards and keeping blade guard as close as possible to portion of meat being cut?

  Yes

  No

  N/A

• Is the saw shut off, with blade guard fully closed?

  Yes

  No

  N/A

• Are items stacked properly on shelving so as to not fall on employees, while also maintaining an 18 inch plane of clearance around room from sprinkler heads?

  Yes

  No

  N/A

• Are chemicals used in the department contained in properly labeled bottles?

  Yes

  No

  N/A

• Are chemicals being stored properly in the department (they should never stored above food)?<br>

  Yes

  No

  N/A

• Is the department adhering to the policy of not removing chemicals from the shelves?

  Yes

  No

  N/A

• Are all knives being stored properly when not in use? Look for unattended knives at various work stations.

  Yes

  No

  N/A

• Is the department free of obvious electrical hazards including, but not limited to electrical panels, missing or improper labeling, frayed wires, missing ground plugs, broken light switches, etc.?

  Yes

  No

  N/A

• Are electrical panels free of obstructions?

  Yes

  No

  N/A

• Are safety signs and labels in place and intact? This includes minimum age usage signs, warning labels, exit signs, etc. Please note any deficiencies.

  Yes

  No

  N/A

• Additional Comments or corrective actions.

Interview 1 Non-Manager Employee from the Meat Department.

• Name of interviewed employee

• Do you have any concerns in regards to safety that you feel we need to address?

  yes

  no

• What are your concerns?

• Have you spoken to a manager about these concerns?

  yes

  no

• Were these concerns that you raised properly addressed by your manager?

  Yes

  No

  N/A

• Have you received any of the following training? Check box if training was received.

• Chemical training? The employee should know what Safety Data Sheets are, that there is first aid information on them, where the eyewash station is and how to use it, and how to read labels on chemical bottles.

• Emergency Evacuation training?

• Compactor use, if over 18?

• Knife training?

• Have the employee explain the important training points regarding knife use. Does the employee display good knowledge? The employee should be able to explain the use of a cut resistant glove, to never leave a knife laying out unattended, and also how to clean the knife properly.

  Yes

  No

  N/A

• Lock Out Tag Out trained?

  yes

  no

• Have employee describe LOTO procedure. Can they go through all the steps properly including mentioning that they test for power?

  Yes

  No

  N/A

• Powered Industrial Equipment trained?

  yes

  no

• Have employee describe the training that they received and how long the session was. Does the employee appear competent to use the equipment? Some items they should be able to discuss are stability triangle and weight capacity.

  Yes

  No

  N/A

• Has the employee received any other safety related training? If yes, please list additional training.

  yes

  no

• Does the employee seem knowledgeable in regards to his/her training?<br>

  Yes

  No

  N/A

• If there was a small amount of blood spilled on the floor, would you clean it up?

  yes

  no

• What would you do? Note answer. Answer should be inform a manager.

• Inform the employee that they are not authorized to clean up blood and that they must inform a manager if they encounter a blood spill or any other accident.

Produce Department

• Is the cooler, prep room, and back room area free of debris and excess liquids (slip/trip hazards)?

  Yes

  No

  N/A

• Are latches on cooler or freezer doors in proper working order so as to prevent entrapment?<br>

  Yes

  No

  N/A

• Are display cases, racks, spot coolers, etc. are in in proper repair as to not cause injury to an employee? Look for broken parts, loose shelving, protruding objects, frayed wires, etc. If no, explain.

  Yes

  No

  N/A

• Are items stacked properly on shelving and on pallets so as to not fall on employees, while also maintaining an 18 inch plane of clearance around room from sprinkler heads?

  Yes

  No

  N/A

• Are chemicals used in the department contained in properly labeled bottles?

  Yes

  No

  N/A

• Are chemicals being stored properly in the department (they should never stored above food)?<br>

  Yes

  No

  N/A

• Is the department adhering to the policy of not removing chemicals from the shelves?

  Yes

  No

  N/A

• Are all knives being stored properly when not in use? Look for unattended knives at various work stations.

  Yes

  No

  N/A

• Is the department free of obvious electrical hazards including, but not limited to electrical panels, missing or improper labeling, frayed wires, missing ground plugs, broken light switches, etc.?

  Yes

  No

  N/A

• Are electrical panels free of obstructions?

  Yes

  No

  N/A

• Are safety signs and labels in place and intact? This includes minimum age usage signs, warning labels, exit signs, etc. Please note any deficiencies.

  Yes

  No

  N/A

• Additional Comments or corrective actions.

Interview 1 Non-Manager Employee from the Produce Department.

• Name of interviewed employee

• Do you have any concerns in regards to safety that you feel we need to address?

  yes

  no

• What are your concerns?

• Have you spoken to a manager about these concerns?

  yes

  no

• Were these concerns that you raised properly addressed by your manager?

  Yes

  No

  N/A

• Have you received any of the following training? Check box if training was received.

• Chemical training? The employee should know what Safety Data Sheets are, that there is first aid information on them, where the eyewash station is and how to use it, and how to read labels on chemical bottles.

• Emergency Evacuation training?

• Compactor use, if over 18?

• Knife training?

• Have the employee explain the important training points regarding knife use. Does the employee display good knowledge? The employee should be able to explain the use of a cut resistant glove, to never leave a knife laying out unattended, and also how to clean the knife properly.

  Yes

  No

  N/A

• Lock Out Tag Out trained?

  yes

  no

• Have employee describe LOTO procedure. Can they go through all the steps properly including mentioning that they test for power?

  Yes

  No

  N/A

• Powered Industrial Equipment trained?

  yes

  no

• Have employee describe the training that they received and how long the session was. Does the employee appear competent to use the equipment? Some items they should be able to discuss are stability triangle and weight capacity.

  Yes

  No

  N/A

• Has the employee received any other safety related training? If yes, please list additional training.

  yes

  no

• Does the employee seem knowledgeable in regards to his/her training?<br>

  Yes

  No

  N/A

• If there was a small amount of blood spilled on the floor, would you clean it up?

  yes

  no

• What would you do? Note answer. Answer should be inform a manager.

• Inform the employee that they are not authorized to clean up blood and that they must inform a manager if they encounter a blood spill or any other accident.

Bakery Department if applicable

• Does this store have a Bakery Department?

  yes

  no

• Is the cooler and back room area free of debris and excess liquids (slip/trip hazards)?

  Yes

  No

  N/A

• Are latches on cooler or freezer doors in proper working order so as to prevent entrapment?<br>

  Yes

  No

  N/A

• Is there any excess ice buildup in any of the freezers either on the ceiling or the floor, including around doorways and the threshold?

  yes

  no

• Are display cases, racks, spot coolers, etc. are in in proper repair as to not cause injury to an employee? Look for broken parts, loose shelving, protruding objects, frayed wires, etc. If no, explain.

  Yes

  No

  N/A

• Are items stacked properly on shelving so as to not fall on employees, while also maintaining an 18 inch plane of clearance around room from sprinkler heads?

  Yes

  No

  N/A

• Are chemicals used in the department contained in properly labeled bottles?

  Yes

  No

  N/A

• Are chemicals being stored properly in the department (they should never stored above food)?<br>

  Yes

  No

  N/A

• Is the department adhering to the policy of not removing chemicals from the shelves?

  Yes

  No

  N/A

• Are all knives being stored properly when not in use? Look for unattended knives at various work stations.

  Yes

  No

  N/A

• Does the department have a first aid kit?

  yes

  no

• Are first aid kits stocked with at least minimum required items?

  Yes

  No

  N/A

• Are first aid kits stocked with at least minimum required items?

  Yes

  No

  N/A

• Is the department free of obvious electrical hazards including, but not limited to electrical panels, missing or improper labeling, frayed wires, missing ground plugs, broken light switches, etc.?

  Yes

  No

  N/A

• Are electrical panels free of obstructions?

  Yes

  No

  N/A

• Are safety signs and labels in place and intact? This includes minimum age usage signs, warning labels, exit signs, etc. Please note any deficiencies.

  Yes

  No

  N/A

• Additional Comments or corrective actions.

Interview 1 Non-Manager Employee from the BakeryDepartment.

• Name of interviewed employee

• Do you have any concerns in regards to safety that you feel we need to address?

  yes

  no

• What are your concerns?

• Have you spoken to a manager about these concerns?

  yes

  no

• Were these concerns that you raised properly addressed by your manager?

  Yes

  No

  N/A

• Have you received any of the following training? Check box if training was received.

• Chemical training? The employee should know what Safety Data Sheets are, that there is first aid information on them, where the eyewash station is and how to use it, and how to read labels on chemical bottles.

• Emergency Evacuation training?

• Compactor use, if over 18?

• Knife training?

• Have the employee explain the important training points regarding knife use. Does the employee display good knowledge? The employee should be able to explain the use of a cut resistant glove, to never leave a knife laying out unattended, and also how to clean the knife properly.

  Yes

  No

  N/A

• Lock Out Tag Out trained?

  yes

  no

• Have employee describe LOTO procedure. Can they go through all the steps properly including mentioning that they test for power?

  Yes

  No

  N/A

• Powered Industrial Equipment trained?

  yes

  no

• Have employee describe the training that they received and how long the session was. Does the employee appear competent to use the equipment? Some items they should be able to discuss are stability triangle and weight capacity.

  Yes

  No

  N/A

• Has the employee received any other safety related training? If yes, please list additional training.

  yes

  no

• Does the employee seem knowledgeable in regards to his/her training?<br>

  Yes

  No

  N/A

• If there was a small amount of blood spilled on the floor, would you clean it up?

  yes

  no

• What would you do? Note answer. Answer should be inform a manager.

• Inform the employee that they are not authorized to clean up blood and that they must inform a manager if they encounter a blood spill or any other accident.

Kitchen/Cafe Department if applicable

• Does this store have a Kitchen and/or cafe?

  yes

  no

• Is the cooler and back room area free of debris and excess liquids (slip/trip hazards)?

  Yes

  No

  N/A

• Are display cases, racks, spot coolers, etc. are in in proper repair as to not cause injury to an employee? Look for broken parts, loose shelving, protruding objects, frayed wires, etc. If no, explain.

  Yes

  No

  N/A

• Are latches on cooler or freezer doors in proper working order so as to prevent entrapment?<br>

  Yes

  No

  N/A

• Is equipment in proper repair so as to not injure an employee?

  Yes

  No

  N/A

• Are items stacked properly on shelving so as to not fall on employees, while also maintaining an 18 inch plane of clearance around room from sprinkler heads?

  Yes

  No

  N/A

• Are chemicals used in the department contained in properly labeled bottles?

  Yes

  No

  N/A

• Are chemicals being stored properly in the department (they should never stored above food)?<br>

  Yes

  No

  N/A

• Is the department adhering to the policy of not removing chemicals from the shelves?

  Yes

  No

  N/A

• Are all knives being stored properly when not in use? Look for unattended knives at various work stations.

  Yes

  No

  N/A

• Does the department have a first aid kit?

  yes

  no

• Are first aid kits stocked with at least minimum required items?

  Yes

  No

  N/A

• Is the department free of obvious electrical hazards including, but not limited to electrical panels, missing or improper labeling, frayed wires, missing ground plugs, broken light switches, etc.?

  Yes

  No

  N/A

• Are electrical panels free of obstructions?

  Yes

  No

  N/A

• Are safety signs and labels in place and intact? This includes minimum age usage signs, warning labels, exit signs, etc. Please note any deficiencies.

  Yes

  No

  N/A

• Additional Comments or corrective actions.

Interview 1 Non-Manager Employee from the Department.

• Name of interviewed employee

• Do you have any concerns in regards to safety that you feel we need to address?

  yes

  no

• What are your concerns?

• Have you spoken to a manager about these concerns?

  yes

  no

• Were these concerns that you raised properly addressed by your manager?

  Yes

  No

  N/A

• Have you received any of the following training? Check box if training was received.

• Chemical training? The employee should know what Safety Data Sheets are, that there is first aid information on them, where the eyewash station is and how to use it, and how to read labels on chemical bottles.

• Emergency Evacuation training?

• Compactor use, if over 18?

• Knife training?

• Have the employee explain the important training points regarding knife use. Does the employee display good knowledge? The employee should be able to explain the use of a cut resistant glove, to never leave a knife laying out unattended, and also how to clean the knife properly.

  Yes

  No

  N/A

• Lock Out Tag Out trained?

  yes

  no

• Have employee describe LOTO procedure. Can they go through all the steps properly including mentioning that they test for power?

  Yes

  No

  N/A

• Powered Industrial Equipment trained?

  yes

  no

• Have employee describe the training that they received and how long the session was. Does the employee appear competent to use the equipment? Some items they should be able to discuss are stability triangle and weight capacity.

  Yes

  No

  N/A

• Has the employee received any other safety related training? If yes, please list additional training.

  yes

  no

• Does the employee seem knowledgeable in regards to his/her training?<br>

  Yes

  No

  N/A

• If there was a small amount of blood spilled on the floor, would you clean it up?

  yes

  no

• What would you do? Note answer. Answer should be inform a manager.

• Inform the employee that they are not authorized to clean up blood and that they must inform a manager if they encounter a blood spill or any other accident.

• During this audit were any items discovered that require corrective action?

  yes

  no

• Please corrective action recommendations.

• Please enter any additional information or concerns regarding this audit.

• Signature of Person in Charge.

  Sign

Overall Store Items

• Is the employee bulletin board up to date and contain pertinent safety related information?

  Yes

  No

  N/A

• Is the HazCom/MSDS binder and the I2P2/Emergency action plan binder both located in the lunch room and made easily accessible?

  Yes

  No

  N/A

• Is the eyewash station being checked on a monthly basis?

  Safe

  At Risk

  N/A

• Is the correct PPE being used for different job tasks? If no, please note department, PPE, and task.

  Yes

  No

  N/A

• Are fire exits unblocked, maintaining a minimum of 28 inches of clearance?<br>

  Safe

  At Risk

  N/A

• Are fire extinguishers being checked on a a monthly basis?

  Yes

  No

  N/A

• Are all Powered Industrial Equipment being inspected on a daily basis and being recorded on the log sheet?

  Yes

  No

  N/A

• Are guardrails in place on the tops of coolers or loft areas and include a swing gate if ladder access is utilized?

  Yes

  No

  N/A

• Are staircases free of slip/trip hazards? If no, please note location and take photo of condition.

  Yes

  No

  N/A

• Are step stools in proper working order?

  Yes

  No

  N/A

• Are ladders in proper working order?

  Yes

  No

  N/A