Kerby - Site Safety Inspection

• Site

• Location
  Address

• Inspection By

• Date

  Date

• Instructions:
  ----------------
  1. Answer "Yes", "No", "N/A" for the questions.
  2. Add photos and notes by clicking on the paperclip icon, if applicable.
  3. To add a Corrective Actions click on the paperclip icon then "Add Action", provide a description, assign to a member, set priority and due date.
  4. Complete audit by providing digital signature.
  5. Share your report by exporting as PDF, Word, Excel or Web Link.
  
  Points Reference: A (90-100) B (80-89) C (70-79) F (<70)

A. Walking Surfaces

• Aisles are established and kept clear

  Yes

  No

  N/A

• No tripping hazards present

  Yes

  No

  N/A

• Minimal holes and cracks

  Yes

  No

  N/A

• Floors are kept dry as practical

  Yes

  No

  N/A

• Ladders in good operating condition

  Yes

  No

  N/A

• Scaffold inspected & in use properly

  Yes

  No

  N/A

B. Electrical Hazards

• Ext. cords not used as permanent source

  Yes

  No

  N/A

• All ext. cords are of 3-wire type

  Yes

  No

  N/A

• Ext. cords plugged directly into outlet

  Yes

  No

  N/A

• Ext. cords in good condition (no tape)

  Yes

  No

  N/A

• All outlet/junction box covers in place

  Yes

  No

  N/A

• Circuit panels are kept clear (min. 36 inches)

  Yes

  No

  N/A

• Circuits are not overloaded

  Yes

  No

  N/A

• Wires/cords do not run under carpet/rugs

  Yes

  No

  N/A

• Wires/cords do not run in traffic areas

  Yes

  No

  N/A

C. Fire Prevention, Emergency Exits

• Fire extinguishers are not obstructed

  Yes

  No

  N/A

• Fire doors are not blocked

  Yes

  No

  N/A

• Exits are unobstructed & unlocked

  Yes

  No

  N/A

• Exits properly marked

  Yes

  No

  N/A

• Good housekeeping is practised

  Yes

  No

  N/A

• Liquid spills are absorbed

  Yes

  No

  N/A

• Excess trash/paper is removed

  Yes

  No

  N/A

• Flam/comb liquids/gas bottles stored proper

  Yes

  No

  N/A

• Space heaters are UL listed

  Yes

  No

  N/A

D. Mobile Equipment

• Persons operating present training cards

  Yes

  No

  N/A

• Operator has conducted check of machine

  Yes

  No

  N/A

• Seatbelt is worn properly

  Yes

  No

  N/A

• Speed limits are observed

  Yes

  No

  N/A

• Forks maintained at proper riding height

  Yes

  No

  N/A

• Machine is in good operating condition

  Yes

  No

  N/A

E. General

• Adherence to smoking policies

  Yes

  No

  N/A

• Work vehicles in good operating condition

  Yes

  No

  N/A

• Personal Protective Equipment

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Completion

• Inspected By: (Name & Signature)

  Sign