Laser Safety Checklist

• Facility Name

• Facility Address
  Address

• Inspected by

• Conducted on

  Date

Personal Protective Equipment

• Are employees wearing safety glasses?

  Yes

  No

  Not Applicable

• Are employees wearing cut protective sleeves?

  Yes

  No

  Not Applicable

• Are employees wearing hearing protection?

  Yes

  No

  Not Applicable

• Are employees wearing gloves?

  Yes

  No

  Not Applicable

• Are welders wearing respirators?

  Yes

  No

  Not Applicable

Housekeeping

• Is work area organized, free of clutter, and trip hazards?

  Yes

  No

  Not Applicable

• Are walk areas clear?

  Yes

  No

  Not Applicable

• Are blow-off air tool nozzles less than 20 psi?

  Yes

  No

  Not Applicable

Electrical

• Are extension cords free of cuts, abrasions, exposed wiring, or other hazards?

  Yes

  No

  Not Applicable

• Are ground pins located on extension cords?

  Yes

  No

  Not Applicable

• Are locks and tags used to lockout / tagout machines under service or repair?

  Yes

  No

  Not Applicable

Machine Guarding

• Are gears, pulleys, and other moving parts covered with machine guards, cabinets, covers, chains, and sensors?

  Yes

  No

  Not Applicable

Other Hazards

• Are oxygen and flammable cylinders stored more than 20 feet apart and secured?

  Yes

  No

  Not Applicable

• Is work area free of other hazards?

  Yes

  No

  Not Applicable

Sign Off

• Additional Observations

• Laser Safety Officer Name & Signature

  Sign