Information

  • Store Number

  • Store Manager Name

  • Conducted on

  • Audit Prepared by

  • Location

Courtesy Booth & Check Out

Courtesy Booth

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

  • Is the floor free of debris (slip/trip hazards)? If not, the appropriate warning signs should be displayed (wet floor cone, caution sign, etc.)?

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

  • Are the Lock Out Tag Out log sheets up to date with correct information being recorded on them? Look for missing data.

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

  • 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.?

  • Are electrical panels free of obstructions?

  • Are first aid kits stocked with at least minimum required items? List revised April 2016.

  • Are there any safety related concerns present in the department that are not listed in the audit? If yes, explain.

  • Are there any additional electrical concerns? If yes please list.

  • Are there any additional safety concerns with this department?

Check Out Area

  • Are associates that are working outside in areas off of the sidewalk wearing the provided ANSI Class II reflective vests or jackets?

  • Are carriage clerks pushing no more than 6 carriages at one time?

  • Are exits/emergency exits free from obstructions?

  • Are the floors free of any apparent slip/trip hazards? If not, the appropriate warning signs should be displayed (wet floor cone, caution sign, etc.). Check entry ways inside and out in addition to floor up front.

  • 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. This helps to promote proper ergonomics.

  • Are anti-fatigue mats provided for the Cashiers?

  • Are chemicals used in the department contained in properly labeled bottles? Be sure to check maintenance closet and utility carts in addition to the checkout area.

  • Is the department adhering to the policy of not removing chemicals from the shelves? Be sure to check bussteller, maintenance closet, bathroom cart, and utility carts in addition to the checkout area.

  • 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.? (Check mart carts, soda coolers, kiddie rides outside, missing weatherproof outlet covers, etc.)

  • Are there any additional electrical concerns? If yes please list.

  • Are electrical panels free of obstructions? Be sure to check the bottle room if applicable.

  • Are storage racks/shelving in good repair and free of bent uprights, load bars/shelving, beam connectors, or any other racking concerns?

  • Are there any safety related concerns present in the department that are not listed in the audit? If yes, explain.

  • Are there any additional safety concerns with this department?

Grocery Department

Grocery Department

  • Is the sales floor free of debris and excess liquids (slip/trip hazards)? If not, the appropriate warning signs should be displayed (wet floor cone, caution sign, etc.)

  • Is the back room area free of debris and excess liquids (slip/trip hazards)? If not, the appropriate warning signs should be displayed (wet floor cone, caution sign, etc.)

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

  • Are storage racks/shelving in good repair and free of bent uprights, load bars/shelving, beam connectors, or any other racking concerns?

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

  • Are gigs and pallets in proper working condition?

  • Are pallet wheels being stored properly so as to not fall over or obstruct walkways? Pallet wheels should be stored under pallets or in a designated area when not in use.

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

  • Is the PPE (chemical splash goggles, chemical resistant gloves, and water canister) worn when topping off the PIE and Floor Equipment batteries available and in proper working order?

  • Are dock plates stored securely when not in use?

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

  • Is the department adhering to the policy of not removing chemicals from the shelves? Check in desks or other storage areas.

  • 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.?

  • Are there any additional electrical concerns? If yes please list.

  • Are electrical panels free of obstructions?

  • Are there any safety related concerns present in the department that are not listed in the audit? If yes, explain.

  • Are there any additional safety concerns with this department?

Dairy Department

Dairy Department

  • Is the cooler and back room area free of debris and excess liquids (slip/trip hazards)? If not, the appropriate warning signs should be displayed (wet floor cone, caution sign, etc.)

  • Are storage racks/shelving in good repair and free of bent uprights, load bars/shelving, beam connectors, or any other racking concerns?

  • Are cooler and freezer doors free of obstructions, allowing for easy access by Associates from either side?

  • Are pallet wheels being stored properly so as to not fall over or obstruct walkways? Pallet wheels should be stored under pallets or in a designated area when not in use.

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

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

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

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

  • Is the department adhering to the policy of not removing chemicals from the shelves? Check in desks or other storage areas.

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

  • 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.?

  • Are there any additional electrical concerns? If yes please list.

  • Are electrical panels free of obstructions?

  • Are there any safety related concerns present in the department that are not listed in the audit? If yes, explain.

  • Are there any additional safety concerns with this department?

Deli Department

Deli/Seafood Department

  • Are floors behind the deli/seafood counter, the cooler, and back room area free of debris and excess liquids (slip/trip hazards)? If not, the appropriate warning signs should be displayed (wet floor cone, caution sign, etc.)

  • Are cooler and freezer doors free of obstructions, allowing for easy access by associates from either side?

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

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

  • Are storage racks/shelving in good repair and free of bent uprights, load bars/shelving, beam connectors, or any other racking concerns?

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

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

  • Is PPE available in the department and in good working condition, (cutting glove not frayed, splash goggles with clean and clear lenses)?

  • Is the department adhering to the policy of not removing chemicals from the shelves? Check in desks or other storage areas.

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

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

  • Are heat resistant gloves in good repair and available for use for the oven, lobster steamer, and microwave?

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

  • Have a Deli Associate describe policies or procedures in place to help prevent injuries with the deli slicer and other equipment. Can the associate describe various injury prevention measures including closing the slicer blade, cutting glove use, etc?

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

  • 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.?

  • Are there any additional electrical concerns? If yes please list.

  • Are electrical panels free of obstructions?

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

  • Are there any safety related concerns present in the department that are not listed in the audit? If yes, explain.

  • Are there any additional safety concerns with this department?

Meat Department

Meat Department

  • Is the cooler and back room area free of debris and excess liquids (slip/trip hazards)? If not, the appropriate warning signs should be displayed (wet floor cone, caution sign, etc.)

  • Have a Meat Associate describe policies or procedures in place to help prevent injuries with equipment in the department. Can the associate describe various injury prevention measures including the use of cutting glove , LOTO, caution signs, proper housekeeping, etc?

  • Are cooler and freezer doors free of obstructions, allowing for easy access by employees from either side?

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

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

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

  • Are storage racks/shelving in good repair and free of bent uprights, load bars/shelving, beam connectors, or any other racking concerns?

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

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

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

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

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

  • Is the department adhering to the policy of not removing chemicals from the shelves? Check in desks or other storage areas.

  • Is PPE available in the department and in good working condition, (cutting glove not frayed, splash goggles with clean and clear lenses)?

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

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

  • 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.?

  • Are there any additional electrical concerns? If yes please list.

  • Are electrical panels free of obstructions?

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

  • Are there any safety related concerns present in the department that are not listed in the audit? If yes, explain.

  • Are there any additional safety concerns with this department?

Produce Department

Produce Department

  • Is the sales floor, cooler, prep room, and back room area free of debris and excess liquids (slip/trip hazards)? If not, the appropriate warning signs should be displayed (wet floor cone, caution sign, etc

  • Are cooler doors free of obstructions, allowing for easy access by associates from either side?

  • Does the cooler slide/open properly so as to prevent entrapment?<br>

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

  • Are storage racks/shelving in good repair and free of bent uprights, load bars/shelving, beam connectors, or any other racking concerns?

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

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

  • Is PPE available in the department and in good working condition, (cutting glove not frayed, splash goggles with clean and clear lenses)?

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

  • Is the department adhering to the policy of not removing chemicals from the shelves? Check in desks or other storage areas.

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

  • 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.?

  • Are there any additional electrical concerns? If yes please list.

  • Are electrical panels free of obstructions?

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

  • Are there any safety related concerns present in the department that are not listed in the audit? If yes, explain.

  • Are there any additional safety concerns with this department?

Bakery Department

Bakery Department if applicable

  • Does this store have a Bakery Department?

  • Is the cooler and back room area free of debris and excess liquids (slip/trip hazards)? If not, the appropriate warning signs should be displayed (wet floor cone, caution sign, etc

  • Are cooler and freezer doors free of obstructions, allowing for easy access by associates from either side?

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

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

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

  • Are storage racks/shelving in good repair and free of bent uprights, load bars/shelving, beam connectors, or any other racking concerns?

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

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

  • Is PPE available in the department and in good working condition, (cutting glove not frayed, splash goggles with clean and clear lenses)?

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

  • Is the department adhering to the policy of not removing chemicals from the shelves? Check in desks or other storage areas.

  • Are heat resistant gloves in good repair and available for use for the oven?

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

  • Does the department have a first aid kit?

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

  • 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.?

  • Are there any additional electrical concerns? If yes please list.

  • Are electrical panels free of obstructions?

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

  • Are there any safety related concerns present in the department that are not listed in the audit? If yes, explain.

  • Are there any additional safety concerns with this department?

Kitchen/Cafe Department

Kitchen/Sub Shop/Cafe Department if applicable

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

  • Is the cooler, behind service counter, and back room area free of debris and excess liquids (slip/trip hazards)? If not, the appropriate warning signs should be displayed (wet floor cone, caution sign, etc

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

  • Are storage racks/shelving in good repair and free of bent uprights, load bars/shelving, beam connectors, or any other racking concerns?

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

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

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

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

  • Is PPE available in the department and in good working condition, (cutting glove not frayed, splash goggles with clean and clear lenses)?

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

  • Is the department adhering to the policy of not removing chemicals from the shelves? Check in desks or other storage areas.

  • Are heat resistant gloves in good repair and available for use for the oven and microwave?

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

  • Does the department have a first aid kit?

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

  • 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.?

  • Are there any additional electrical concerns? If yes please list.

  • Are electrical panels free of obstructions?

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

  • Are there any safety related concerns present in the department that are not listed in the audit? If yes, explain.

  • Are there any additional safety concerns with this department?

General Facility

Overall Store Items

  • Look at the Powered Industrial Truck Inspection form located near the manager office. Briefly question the associate that conducted the inspection of the equipment for that day. Ask the associate what steps that they take to inspect the equipment? Does the associate appear to inspect the equipment properly?

  • Do compressor room, HVAC room, and other areas that are designated as "Authorized Personnel Only" appear to be free of obvious hazards?

  • Are any identified trip hazards in HVAC rooms, compressor rooms, and catwalk areas clearly marked with high visibility paint or tape? If they are not, recommend to management this is done.

  • Are the Compressor rooms and catwalk areas being used to store non-maintenance contractor related materials? The storage in these areas should be limited to light bulbs, refrigeration supplies, HVAC supplies, filters, ceiling tiles, etc. All storage is to be done away from electrical panels and equipment. Excessive storage of items should be addressed immediately by management.

  • Does the compressor room have copies of the SDS for refrigeration related chemicals?

  • Is the HVAC room 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.?

  • Are there any additional electrical concerns? If yes please list.

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

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

  • Is the eyewash station being maintained/checked on a monthly basis, filled to at least to the minimum level line, clean, and in good working order? Open the cap to the eyewash station to see if fluid level is at the fill line and the water is in good condition.

  • Are fire exits unblocked, maintaining a minimum of 28 inches of clearance? Please note area if applicable. <br>

  • Do fire exit work properly, open freely, and alarm sounds when opened? Make sure exits are not obstructed or that other hazards aren't present on the other side of the door.<br>

  • Are fire extinguishers being checked on a monthly basis?

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

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

  • Is the helium tank stored properly (upright position, securely chained to the wall so it will not fall over, regulator removed, and capped)?

  • Are step stools in proper working order?

  • Are ladders in proper working order?

  • Are there any safety related concerns present that are not listed in the audit? If yes, explain.

  • Are there any additional safety concerns present?

Departmant Manager Interview #1

Standard Interview #1 - Department Manager

  • Name of interviewed Department Manager

  • Department

  • Do you have any concerns in regards to safety that you feel we need to address? This could be one your concerns, a concern or complaint from another associate, or a near miss. If yes, please describe in detail.

  • Have you spoken to the store manager or supervisor about these concerns?

  • Were these concerns that you raised addressed by your store manager or supervisor?

  • Powered Industrial Equipment trained?

  • Have the associate describe the training that they received and how long the session was. Does the associate appear competent to use the equipment? Some items they should be able to discuss are stability of loads, weight capacity, horn use, etc.

  • Have you received any of the following training? Select yes if training was received and the associate has good knowledge? Select no if the associate does not display good working knowledge. Select N/A if the training type does not apply.

  • Can the Manager explain the chemical training that they received, the training that they provide to associates, and is that training in accordance with company policy? The manager should touch upon the use of training materials/information, demonstration of chemical use, chemical hazards, SDS review, PPE training, etc. <br>

  • Can the Manager explain the hazards associated with some of the chemicals in the department and the protective measures in place to help mitigate them? The manager should mention department procedures and PPE at minimum.

  • Have the Manager locate the SDS for a chemical used in the department. Can the Manager navigate the SDS easily to provide information about the hazards, first aid measures, PPE requirements, and any other pertinent information?<br>

  • Can the Manager explain the location of and how to use the eyewash station? The answer should include holding eyes open with their fingers and the flush time which should range from a few minutes to 15 minutes, depending on the chemical that was used. The information for the actual flush times are located on the SDS, which the Manager should understand as well. <br>

  • Can the manager explain the training provided in regards to handling materials? The Manager should be able to provide information about lifting techniques, devices used to transport materials, stacking materials, etc.

  • Emergency Evacuation training? Can the Manager describe the quickest way out of the building, where the designated meeting area is located, and what his/her role is during the evacuation (make sure their associates get out and take attendance)?

  • Does the Manager know the location of available first aid kits in case there was an accident? The Manager should understand at minimum that their is a first aid kit in the Courtesy Booth. There may be one in the department depending on the the store. Verify.

  • Compactor use, if over 18? The Manager should know about age restriction of 18 years or older, close door prior to turning on the compactor, and never to climb in the compactor.

  • Knife training? If the manager is not trained to use a knife as part of the job description, please select N/A.

  • Have the manager explain the important training points they give associates regarding knife use. Does the manager display good knowledge? The manager 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.

  • Lock Out Tag Out trained?

  • Can the manager explain the importance of why LOTO is used for certain equipment? The manager should be able to explain how to control energy sources. Ask the manager a few questions about what equipment gets locked out and how the process is explained to associates.

  • Ask the manager about the last safety related training or talks he/she conducted? When was the last training or talk and what was the topic?

  • If there was an accident involving a blood spill, can the manager explain what the company policy is in regards to the situation? Does the manager know who is authorized to clean it up?

Department Manager Interview #2

Standard Interview #1 - Department Manager

  • Name of interviewed Department Manager

  • Department

  • Do you have any concerns in regards to safety that you feel we need to address? This could be one your concerns, a concern or complaint from another associate, or a near miss. If yes, please describe in detail.

  • Have you spoken to the store manager or supervisor about these concerns?

  • Were these concerns that you raised addressed by your store manager or supervisor?

  • Powered Industrial Equipment trained?

  • Have the associate describe the training that they received and how long the session was. Does the associate appear competent to use the equipment? Some items they should be able to discuss are stability of loads, weight capacity, horn use, etc.

  • Have you received any of the following training? Select yes if training was received and the associate has good knowledge? Select no if the associate does not display good working knowledge. Select N/A if the training type does not apply.

  • Can the Manager explain the chemical training that they received, the training that they provide to associates, and is that training in accordance with company policy? The manager should touch upon the use of training materials/information, demonstration of chemical use, chemical hazards, SDS review, PPE training, etc. <br>

  • Can the Manager explain the hazards associated with some of the chemicals in the department and the protective measures in place to help mitigate them? The manager should mention department procedures and PPE at minimum.

  • Have the Manager locate the SDS for a chemical used in the department. Can the Manager navigate the SDS easily to provide information about the hazards, first aid measures, PPE requirements, and any other pertinent information?<br>

  • Can the Manager explain the location of and how to use the eyewash station? The answer should include holding eyes open with their fingers and the flush time which should range from a few minutes to 15 minutes, depending on the chemical that was used. The information for the actual flush times are located on the SDS, which the Manager should understand as well. <br>

  • Can the manager explain the training provided in regards to handling materials? The Manager should be able to provide information about lifting techniques, devices used to transport materials, stacking materials, etc.

  • Emergency Evacuation training? Can the Manager describe the quickest way out of the building, where the designated meeting area is located, and what his/her role is during the evacuation (make sure their associates get out and take attendance)?

  • Does the Manager know the location of available first aid kits in case there was an accident? The Manager should understand at minimum that their is a first aid kit in the Courtesy Booth. There may be one in the department depending on the the store. Verify.

  • Compactor use, if over 18? The Manager should know about age restriction of 18 years or older, close door prior to turning on the compactor, and never to climb in the compactor.

  • Knife training? If the manager is not trained to use a knife as part of the job description, please select N/A.

  • Have the manager explain the important training points they give associates regarding knife use. Does the manager display good knowledge? The manager 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.

  • Lock Out Tag Out trained?

  • Can the manager explain the importance of why LOTO is used for certain equipment? The manager should be able to explain how to control energy sources. Ask the manager a few questions about what equipment gets locked out and how the process is explained to associates.

  • Ask the manager about the last safety related training or talks he/she conducted? When was the last training or talk and what was the topic?

  • If there was an accident involving a blood spill, can the manager explain what the company policy is in regards to the situation? Does the manager know who is authorized to clean it up?

Closing Manager Interview

Manager Interview - This interview is to be conducted with a Blood Pathogen Trained Manager?

  • Name and position of manager

  • Do you have any concerns in regards to safety that you feel we need to address? If yes, please describe in detail.

  • Have you spoken your manager or supervisor about these concerns?

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

  • Have you received any of the following training? Select yes if training was received and employee has good knowledge? Select no if employee does not display good working knowledge. Select N/A if the training type does not apply.

  • If there were an emergency situation involving another associate, can the associate provide some explanation as to how they would properly assist in handling the situation?

  • Can the Manager explain the chemical training that they received, the training that they provide to associates, and is that training in accordance with company policy? The manager should touch upon the use of training materials/information, demonstration of chemical use, chemical hazards, SDS review, PPE training, etc. <br>

  • Can the Manager explain the hazards associated with some of the chemicals in the department and the protective measures in place to help mitigate them? The manager should mention department procedures and PPE at minimum.

  • Have the Manager locate the SDS for a chemical used in the department. Can the Manager navigate the SDS easily to provide information about the hazards, first aid measures, PPE requirements, and any other pertinent information?<br>

  • Can the Manager explain the location of and how to use the eyewash station? The answer should include holding eyes open with their fingers and the flush time which should range from a few minutes to 15 minutes, depending on the chemical that was used. The information for the actual flush times are located on the SDS, which the Manager should understand as well. <br>

  • Can the manager explain the training provided in regards to handling materials? The Manager should be able to provide information about lifting techniques, devices used to transport materials, stacking materials, etc.

  • Training on how to lift items? Can the associate explain proper lifting techniques?

  • Emergency Evacuation training? What is the designated area that you need to report to, using the quickest way out, and as a manager what is your responsibility during an evacuation?

  • Compactor use, if over 18? The associate should know about age restriction of 18 years or older, close door prior to turning on the compactor, and never to climb in the compactor.

  • Ask the Manager what he/she would do in the event of a blood spill. Is the manager able to accurately describe the steps on how to clean up the blood?

  • Ask the manager if they are Lock out Tag out trained. Was the manager trained as part of the annual review, which includes an actual hands on demonstration?

  • Powered Industrial Equipment trained?

  • 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.

Material Handling Interview

Material Handling Interview - To be conducted with any associate/manager in the process of Lifting or handling cases

  • Name of interviewed Associate

  • Department Associate works in.

  • You have selected an associate that is in the process of lifting items or handling materials. Are they doing so in proper form? If they are not, take a moment to correct his/her form before proceeding with the remainder of the interview. If the associate is the material properly, commend them on their technique.

  • Explain to the associate that you are looking to discuss the training that he/she received in regards to lifting or handling boxes, cases, product, etc. Can the associate describe the type of training that he/she received and does that training consist of various techniques on lifting certain items or handling materials?

  • Training on how to lift items? Can the employee demonstrate proper lifting techniques?

  • Does the associate know what a team lift is and when to utilize it? (Chep pallet if they can't lift it, dock plate, etc.)<br>

  • Can the associate describe various ways that they transport material around the building?<br>

  • Has your manager conducted any safety related training or talks lately? When was the last training or talk and what was the topic?

Powered Industrial Truck Trained Associate Interview

Powered Industrial Truck Trained Associate

  • How long has the associate been operating Powered Industrial Trucks (PIT)?

  • When did the associate last receive training or refresher training on PIT?

  • Does the associate feel comfortable operating the PIT?

  • Ask the associate about his/her training. Does the associate seem proficient in the areas listed below? List any deficiencies.

  • Understands the importance of load stability.<br>

  • Knows capacity of truck and can locate identification plate on the vehicle.

  • Does the associate know where the emergency shut off is located (if applicable) and safety features of the vehicle?

  • Understands when to sound horn (i.e. at intersections, corners, and when vision is obstructed).

  • Can explain why debris must not be run over with the PIT.

  • Does the associate know what to do if the PIT is not operating properly and what happens to the PIT? The answer should include report to manager who will take it out of service.

Safety File Review

Safety Files and Training Documentation

  • The safety files and training records should be up to date and in a logical order. Please review the file system with the manager. Look for missing or unsigned records. How would you rate the record keeping and organization of the files? 1 = lowest (no organization, missing or hard to find records) 5 = highest (some minor issues, but otherwise in great order)

  • Review the OSHA 300 logs for injuries this year and last year. Are the managers keeping accurate logs, including not having multiple logs for the same year? If the manager has multiple copies of a single years log, question it and determine which is the most up to date one. If it cannot be determined, have the manager contact Jeannine Marquis to send the most up to date log.<br>

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

  • Review the injury investigation file. Is the manager conducting adequate injury investigations including the identification of the root cause and providing corrective actions? Reminder, instructing the associate to be more careful is not a corrective action, nor is failing to retrain an associate that fails to follow company policy or procedure.

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

  • Are the employee training forms in good order. Spot check the employee training records to verify that training records are in good order and filled out properly.

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

  • 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>

  • Review the chemical training files. Spot check 2 departments and verify that the revised chemical training had been completed for active associates. Is the training up to date?

  • 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.

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

  • Review the training documentation for the powered industrial trucks. Are the file in good order, including an authorized user list?

  • Spot check the powered industrial training documentation for several users. Are the documents completely filled out, including the having the required signatures, initials, and valid dates of training?

  • Have the manager access the SDS on the Health and Safety Homepage. Give the manager a chemical to search for. Can the manager quickly access the system and find the SDS?

  • Are there any additional concerns with the file or record keeping system?

Wrap Up

  • During this audit were any items discovered that require corrective action? Please enter corrective action recommendations, if applicable.

  • During the audit were there any repeat negative findings when compared to the last corporate audit? If yes, instruct the manager that the repeat finding must be corrected immediately. If the finding cannot be corrected immediately then work out a feasible timeline in which to correct the finding(s). <br>No repeats - full credit towards score<br>1 repeat - half credit towards score<br>2 repeats - no credit towards score<br>3 repeats - additional half credit deduction from score<br>4 or more repeats - additional full credit deduction from score<br>

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

  • Signature of Person in Charge.

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