Laird - MSV

• Audit Title

• Site

• Conducted on

  Date

• Prepared by

• Personnel

Part 1: Hazard Identification

Emergency

• Are means of egress clear and unobstructed?

  Yes

  No

  N/A

• Is access to fire extinguishers and emergency equipment clear and unobstructed?

  Yes

  No

  N/A

• Are all entrance doors into stairwells & exterior exit doors identified with exit signage?

  Yes

  No

  N/A

Housekeeping

• Is the floor free of debris and slippery conditions?

  Yes

  No

  N/A

• Are items stored neatly to prevent hazards?

  Yes

  No

  N/A

• Does the housekeeping in the area meet site internal standards?

  Yes

  No

  N/A

Machine - Equipment - Tools

• Is all equipment in safe working condition?

  Yes

  No

  N/A

• Are tools and equipment being used properly?

  Yes

  No

  N/A

• Are proper guards in place on tools and equipment?

  Yes

  No

  N/A

Lockout Tagout

• During maintenance or potential exposure to hazardous energy, are all energy sources locked out?

  Yes

  No

  N/A

• Is one person - one lock on every point of power being locked out?

  Yes

  No

  N/A

• Are danger tags used only yo supplement locks?

  Yes

  No

  N/A

Electrical Safety

• Are all flexible cords and cables free of cracks, cuts, frays, and knots?

  Yes

  No

  N/A

• When flex cords enter equipment enclosures, are they protected by grommets from physical damage?

  Yes

  No

  N/A

• Are the faceplates on outlets and switches in good condition?

  Yes

  No

  N/A

Other

• Are there any other hazards identified in your inspection?

  Yes

  No

  N/A

Identified Hazards and Corrective Actions:

• Please list identified hazards and recommended corrective actions.

Part 2: Behavior Observation

PPE

• Is necessary PPE being worn?

  Yes

  No

  N/A

• Is PPE adequate for the job?

  Yes

  No

  N/A

• Is PPE in good condition?

  Yes

  No

  N/A

Safety Procedure

• Are procedures in place to protect people from injury?

  Yes

  No

  N/A

• Are procedures followed?

  Yes

  No

  N/A

• Are workers trained on the safe work methods and procedures?

  Yes

  No

  N/A

Position

• Is there a possibility of the worker to be struck by or against any object?

  Yes

  No

  N/A

• Is there a possibility for the worker to be caught in or between an object?

  Yes

  No

  N/A

• Is there a possibility of the worker falling from a height?

  Yes

  No

  N/A

• Does the possibility exist that a person could strain themselves due to overexertion, awkward postures, or repetitive motions?

  Yes

  No

  N/A

Reaction of People

• Do workers appear not to have eyes on task?

  Yes

  No

  N/A

• Do workers appear to be rushing?

  Yes

  No

  N/A

• Do workers appear to be at risk of losing their balance, traction, or grip?

  Yes

  No

  N/A

• Did workers put on their PPE just because you are doing an inspection?

  Yes

  No

  N/A

Other

• Was there any other unsafe behavior observed during your inspection?

  Yes

  No

  N/A

Feedback and Coaching

• Recognized safe behavior:

• Coaching of unsafe behavior: