Knife River Midwest Monthly Safety Inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Inspector Name

• Position

• Site Visited

• Date

  Date

• Signature

  Sign

PERSONAL PROTECTIVE EQUIPMENT AS REQUIRED

• Hard Hat

  Yes

  No

  N/A

• Safety Glasses and / or Face Shield

  Yes

  No

  N/A

• Hearing Protection

  Yes

  No

  N/A

• Gloves

  Yes

  No

  N/A

• Safety-Toe Footwear

  Yes

  No

  N/A

• High Visibility Vest Worn (ANSI Class 2 or Class 3)

  Yes

  No

  N/A

• Respirators (if Needed)

  Yes

  No

  N/A

Equipment / Trucks

• Equipment Inspected

  Yes

  No

  N/A

• Guarding of Machine Parts

  Yes

  No

  N/A

• Horns, Lights, Backup Alarms and Cameras Working

  Yes

  No

  N/A

• Seatbelts Worn

  Yes

  No

  N/A

• Floorboard / Cab Free of Clutter

  Yes

  No

  N/A

• Steps Clear of Debris

  Yes

  No

  N/A

• Fire Extinguishers Mounted, Available, Inspected

  Yes

  No

  N/A

WORK/PLANT SITE

• Organized Traffic Flow

  Yes

  No

  N/A

• Adequate Warning Signs and Markers in Place

  Yes

  No

  N/A

• Berms or Guardrails in Place

  Yes

  No

  N/A

• Electrical Hazards

  Yes

  No

  N/A

• Fire Extinguishers Mounted, Available, Inspected

  Yes

  No

  N/A

• Eyewash Stations Inspected and Clear

  Yes

  No

  N/A

• Flammable Liquids and Gasses Controlled

  Yes

  No

  N/A

• SDS Available

  Yes

  No

  N/A

PERSONAL RISK MANAGEMENT

• Worker Responding to Hazards

  Yes

  No

  N/A

• Proper Lifting

  Yes

  No

  N/A

• Worker Trained for Task (Especially New Hires)

  Yes

  No

  N/A

• Workers Protected From Falls

  Yes

  No

  N/A

• Repetitive Motion Hazards

  Yes

  No

  N/A

• Extreme Heat/Cold-Hydration and Breaks

  Yes

  No

  N/A

HOUSEKEEPING

• Doorways / Access Clear

  Yes

  No

  N/A

• Slip or Trip Hazards

  Yes

  No

  N/A

• Hand Tools Neatly Stored

  Yes

  No

  N/A

• Electrical Cords Rolled Up and Stored

  Yes

  No

  N/A

• Vegetation Controlled

  Yes

  No

  N/A

EMPLOYEE INTERVIEW

• Safety Statement?

  Yes

  No

  N/A

• What was the safety statement?

  Yes

  No

  N/A

• Was the Weekly Safety Meeting Understood?

  Yes

  No

  N/A

• Supervisory Support of Safety?

  Yes

  No

  N/A

• Any Unchecked Hazards? (Document in Notes)

  Yes

  No

  N/A

HAND SAFETY OBSERVATIONS

• Appropriate hand protection being worn for task?

  Yes

  No

  N/A

• Does the gloves properly fit employee's hands?

  Yes

  No

  N/A

• Are cuts observed on employee hand(s)? (explain)

  Yes

  No

  N/A

• Comments

• Task Performed

• Notes

REINFORCEMENT OF SAFETY CULTURE

* Safe and Healthful Work Site * Employee Recognized for Safe Behavior

• Audit Positive Comments Here:

* Unsafe Task Observed * Corrective Action Taken

• Audit Corrective Comments Here:

REMEMBER -TALK TO THE TEAM Safe Behaviors Praise Hard Work, Praise Safe Work Recognize Above and Beyond Safety Safety Culture Makes Us World Class Unsafe Behaviors Hurts Workers, Co-Workers, Equipment, Pay Hurts Production, Team Success Not Acceptable to Any Involved

• Comments

• How Can We Be Safer?

  Yes

  No

  N/A