ISS Safety Floor Walk Checklist - TEMPLATE

• Client / Site

• Conducted on

  Date

• Prepared by

Specific Department(s)/Area(s) Audited

Audit Points

• Proper PPE utilized by employees

  Compliant

  Non-Compliant

  N/A

• Action Plan

  Addressed

  Escalated

  In Progress

• Specific location -- Area(s) of Concern

• Dress Code closely adhered to

  Compliant

  Non-Compliant

  N/A

• Action Plan

  Addressed

  Escalated

  In Progress

• Specific location -- Area(s) of Concern

• Workstation/area clear and clean of hazard

  Compliant

  Non-Compliant

  N/A

• Action Plan

  Addressed

  Escalated

  In Progress

• Specific location -- Area(s) of Concern

• Emergency exits clearly marked

  Compliant

  Non-Compliant

  N/A

• Action Plan

  Addressed

  Escalated

  In Progress

• Specific location -- Area(s) of Concern

• Walking/work surfaces free of clutter

  Compliant

  Non-Compliant

  N/A

• Action Plan

  Addressed

  Escalated

  In Progress

• Specific location -- Area(s) of Concern

• PIT lane clearly marked (If applicable)

  Compliant

  Non-Compliant

  N/A

• Action Plan

  Addressed

  Escalated

  In Progress

• Specific location -- Area(s) of Concern

• Ladder/step stools available

  Compliant

  Non-Compliant

  N/A

• Action Plan

  Addressed

  Escalated

  In Progress

• Specific location -- Area(s) of Concern

• Hazardous areas clearly guarded

  Compliant

  Non-Compliant

  N/A

• Action Plan

  Addressed

  Escalated

  In Progress

• Specific location -- Area(s) of Concern

• Work areas properly illuminated

  Compliant

  Non-Compliant

  N/A

• Action Plan

  Addressed

  Escalated

  In Progress

• Specific location -- Area(s) of Concern

• Weather related hazards in parking lot

  Compliant

  Non-Compliant

  N/A

• Action Plan

  Addressed

  Escalated

  In Progress

• Specific location -- Area(s) of Concern

• Cleaning supplies available (Mops, brooms, etc)

  Compliant

  Non-Compliant

  N/A

• Action Plan

  Addressed

  Escalated

  In Progress

• Specific location -- Area(s) of Concern

• Stairways clean and clear of debris

  Compliant

  Non-Compliant

  N/A

• Action Plan

  Addressed

  Escalated

  In Progress

• Specific location -- Area(s) of Concern

• Totes/pallets stacked at correct height and properly located

  Compliant

  Non-Compliant

  N/A

• Action Plan

  Addressed

  Escalated

  In Progress

• Specific location -- Area(s) of Concern

• Job tools available and in proper staging area

  Compliant

  Non-Compliant

  N/A

• Action Plan

  Addressed

  Escalated

  In Progress

• Specific location -- Area(s) of Concern

• Emergency exits outside of building clear of hazards

  Compliant

  Non-Compliant

  N/A

• Action Plan

  Addressed

  Escalated

  In Progress

• Specific location -- Area(s) of Concern

• Parking lot clear of hazards (Trash, debris, etc)

  Compliant

  Non-Compliant

  N/A

• Action Plan

  Addressed

  Escalated

  In Progress

• Specific location -- Area(s) of Concern

• Job tools functioning and in good repair

  Compliant

  Non-Compliant

  N/A

• Action Plan

  Addressed

  Escalated

  In Progress

• Specific location -- Area(s) of Concern

• Health and safety equipment/stations accessible and in good repair (Eye wash stations, etc)

  Compliant

  Non-Compliant

  N/A

• Action Plan

  Addressed

  Escalated

  In Progress

• Specific location -- Area(s) of Concern

Additional observation/interaction

• Associate safety concerns raised (Verbal, VA board, suggestion box, etc)

  Yes

  No

• Unsafe behaviors observed, corrected, or escalated

  Yes

  No

• Additional comments and/or action items

  Yes

  No