LNA Safety Recognition Housekeeping Checklist REV3

• Area Inspected

• Site

• Conducted on

  Date

• Personnel

Entrances & Exits

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  Media

• Clear & Free of Spills and Obstructions

  Select 5 - No Deficient Items 4 - 1 Deficient Item 3 - 2 Deficient Items 2 - 3 Deficient Items 1 - 4 or More Deficient Items N/A - Not Applicable

  • 5 - No Deficient Items
  • 4 - 1 Deficient Item
  • 3 - 2 Deficient Items
  • 2 - 3 Deficient Items
  • 1 - 4 or More Deficient Items
  • N/A - Not Applicable

• Adequate & Well Marked

  Select 5 - No Deficient Items 4 - 1 Deficient Item 3 - 2 Deficient Items 2 - 3 Deficient Items 1 - 4 or More Deficient Items N/A - Not Applicable

  • 5 - No Deficient Items
  • 4 - 1 Deficient Item
  • 3 - 2 Deficient Items
  • 2 - 3 Deficient Items
  • 1 - 4 or More Deficient Items
  • N/A - Not Applicable

Roadways, Parking Areas, & Berms

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• In Good Condition

  Select 5 - No Deficient Items 4 - 1 Deficient Item 3 - 2 Deficient Items 2 - 3 Deficient Items 1 - 4 or More Deficient Items N/A - Not Applicable

  • 5 - No Deficient Items
  • 4 - 1 Deficient Item
  • 3 - 2 Deficient Items
  • 2 - 3 Deficient Items
  • 1 - 4 or More Deficient Items
  • N/A - Not Applicable

• Well Drained & Marked

  Select 5 - No Deficient Items 4 - 1 Deficient Item 3 - 2 Deficient Items 2 - 3 Deficient Items 1 - 4 or More Deficient Items N/A - Not Applicable

  • 5 - No Deficient Items
  • 4 - 1 Deficient Item
  • 3 - 2 Deficient Items
  • 2 - 3 Deficient Items
  • 1 - 4 or More Deficient Items
  • N/A - Not Applicable

• Clear of Trash, Debris, Snow, & Ice

  Select 5 - No Deficient Items 4 - 1 Deficient Item 3 - 2 Deficient Items 2 - 3 Deficient Items 1 - 4 or More Deficient Items N/A - Not Applicable

  • 5 - No Deficient Items
  • 4 - 1 Deficient Item
  • 3 - 2 Deficient Items
  • 2 - 3 Deficient Items
  • 1 - 4 or More Deficient Items
  • N/A - Not Applicable

Escapeways

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  Media

• Clear & Free of Obstructions

  Select 5 - No Deficient Items 4 - 1 Deficient Item 3 - 2 Deficient Items 2 - 3 Deficient Items 1 - 4 or More Deficient Items N/A - Not Applicable

  • 5 - No Deficient Items
  • 4 - 1 Deficient Item
  • 3 - 2 Deficient Items
  • 2 - 3 Deficient Items
  • 1 - 4 or More Deficient Items
  • N/A - Not Applicable

• Well Marked & Illuminated

  Select 5 - No Deficient Items 4 - 1 Deficient Item 3 - 2 Deficient Items 2 - 3 Deficient Items 1 - 4 or More Deficient Items N/A - Not Applicable

  • 5 - No Deficient Items
  • 4 - 1 Deficient Item
  • 3 - 2 Deficient Items
  • 2 - 3 Deficient Items
  • 1 - 4 or More Deficient Items
  • N/A - Not Applicable

Aisles, Floors, & Travelways

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  Media

• Clean & Free of Waste, Spills, Trash, & Accumulations

  Select 5 - No Deficient Items 4 - 1 Deficient Item 3 - 2 Deficient Items 2 - 3 Deficient Items 1 - 4 or More Deficient Items N/A - Not Applicable

  • 5 - No Deficient Items
  • 4 - 1 Deficient Item
  • 3 - 2 Deficient Items
  • 2 - 3 Deficient Items
  • 1 - 4 or More Deficient Items
  • N/A - Not Applicable

• Clear & Free of Obstructions & Tools

  Select 5 - No Deficient Items 4 - 1 Deficient Item 3 - 2 Deficient Items 2 - 3 Deficient Items 1 - 4 or More Deficient Items N/A - Not Applicable

  • 5 - No Deficient Items
  • 4 - 1 Deficient Item
  • 3 - 2 Deficient Items
  • 2 - 3 Deficient Items
  • 1 - 4 or More Deficient Items
  • N/A - Not Applicable

Stairs, Ramps, & Elevated Walkways

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  Media

• Clear & Free of Waste, Spills, Trash, & Accumulations

  Select 5 - No Deficient Items 4 - 1 Deficient Item 3 - 2 Deficient Items 2 - 3 Deficient Items 1 - 4 or More Deficient Items N/A - Not Applicable

  • 5 - No Deficient Items
  • 4 - 1 Deficient Item
  • 3 - 2 Deficient Items
  • 2 - 3 Deficient Items
  • 1 - 4 or More Deficient Items
  • N/A - Not Applicable

• Clear & Free of Obstructions

  Select 5 - No Deficient Items 4 - 1 Deficient Item 3 - 2 Deficient Items 2 - 3 Deficient Items 1 - 4 or More Deficient Items N/A - Not Applicable

  • 5 - No Deficient Items
  • 4 - 1 Deficient Item
  • 3 - 2 Deficient Items
  • 2 - 3 Deficient Items
  • 1 - 4 or More Deficient Items
  • N/A - Not Applicable

Restrooms: Portable & In-House

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  Media

• Available

  Select 5 - No Deficient Items 4 - 1 Deficient Item 3 - 2 Deficient Items 2 - 3 Deficient Items 1 - 4 or More Deficient Items N/A - Not Applicable

  • 5 - No Deficient Items
  • 4 - 1 Deficient Item
  • 3 - 2 Deficient Items
  • 2 - 3 Deficient Items
  • 1 - 4 or More Deficient Items
  • N/A - Not Applicable

• In Clean Condition

  Select 5 - No Deficient Items 4 - 1 Deficient Item 3 - 2 Deficient Items 2 - 3 Deficient Items 1 - 4 or More Deficient Items N/A - Not Applicable

  • 5 - No Deficient Items
  • 4 - 1 Deficient Item
  • 3 - 2 Deficient Items
  • 2 - 3 Deficient Items
  • 1 - 4 or More Deficient Items
  • N/A - Not Applicable

Plant Machinery & Equipment

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  Media

• Clear Of Waste & Spills

  Select 5 - No Deficient Items 4 - 1 Deficient Item 3 - 2 Deficient Items 2 - 3 Deficient Items 1 - 4 or More Deficient Items N/A - Not Applicable

  • 5 - No Deficient Items
  • 4 - 1 Deficient Item
  • 3 - 2 Deficient Items
  • 2 - 3 Deficient Items
  • 1 - 4 or More Deficient Items
  • N/A - Not Applicable

Proper Storage of Tools, Equipment, & PPE

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  Media

• Properly Stored When Not In Use

  Select 5 - No Deficient Items 4 - 1 Deficient Item 3 - 2 Deficient Items 2 - 3 Deficient Items 1 - 4 or More Deficient Items N/A - Not Applicable

  • 5 - No Deficient Items
  • 4 - 1 Deficient Item
  • 3 - 2 Deficient Items
  • 2 - 3 Deficient Items
  • 1 - 4 or More Deficient Items
  • N/A - Not Applicable

Stacking & Storage

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  Media

• Stacks Are Stable & Secure

  Select 5 - No Deficient Items 4 - 1 Deficient Item 3 - 2 Deficient Items 2 - 3 Deficient Items 1 - 4 or More Deficient Items N/A - Not Applicable

  • 5 - No Deficient Items
  • 4 - 1 Deficient Item
  • 3 - 2 Deficient Items
  • 2 - 3 Deficient Items
  • 1 - 4 or More Deficient Items
  • N/A - Not Applicable

• Storerooms/Storage Cabinets Neat & Orderly

  Select 5 - No Deficient Items 4 - 1 Deficient Item 3 - 2 Deficient Items 2 - 3 Deficient Items 1 - 4 or More Deficient Items N/A - Not Applicable

  • 5 - No Deficient Items
  • 4 - 1 Deficient Item
  • 3 - 2 Deficient Items
  • 2 - 3 Deficient Items
  • 1 - 4 or More Deficient Items
  • N/A - Not Applicable

• Properly Labeled

  Select 5 - No Deficient Items 4 - 1 Deficient Item 3 - 2 Deficient Items 2 - 3 Deficient Items 1 - 4 or More Deficient Items N/A - Not Applicable

  • 5 - No Deficient Items
  • 4 - 1 Deficient Item
  • 3 - 2 Deficient Items
  • 2 - 3 Deficient Items
  • 1 - 4 or More Deficient Items
  • N/A - Not Applicable

Combustibles

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  Media

• Combustible Materials Stored Properly

  Select 5 - No Deficient Items 4 - 1 Deficient Item 3 - 2 Deficient Items 2 - 3 Deficient Items 1 - 4 or More Deficient Items N/A - Not Applicable

  • 5 - No Deficient Items
  • 4 - 1 Deficient Item
  • 3 - 2 Deficient Items
  • 2 - 3 Deficient Items
  • 1 - 4 or More Deficient Items
  • N/A - Not Applicable

• Combustible Waste Containers Available

  Select 5 - No Deficient Items 4 - 1 Deficient Item 3 - 2 Deficient Items 2 - 3 Deficient Items 1 - 4 or More Deficient Items N/A - Not Applicable

  • 5 - No Deficient Items
  • 4 - 1 Deficient Item
  • 3 - 2 Deficient Items
  • 2 - 3 Deficient Items
  • 1 - 4 or More Deficient Items
  • N/A - Not Applicable

• Used & Emptied at the End of the Shift

  Select 5 - No Deficient Items 4 - 1 Deficient Item 3 - 2 Deficient Items 2 - 3 Deficient Items 1 - 4 or More Deficient Items N/A - Not Applicable

  • 5 - No Deficient Items
  • 4 - 1 Deficient Item
  • 3 - 2 Deficient Items
  • 2 - 3 Deficient Items
  • 1 - 4 or More Deficient Items
  • N/A - Not Applicable

• Heating & Ventilation Clean, Clear, & Away from Combustible/Flammable Materials

  Select 5 - No Deficient Items 4 - 1 Deficient Item 3 - 2 Deficient Items 2 - 3 Deficient Items 1 - 4 or More Deficient Items N/A - Not Applicable

  • 5 - No Deficient Items
  • 4 - 1 Deficient Item
  • 3 - 2 Deficient Items
  • 2 - 3 Deficient Items
  • 1 - 4 or More Deficient Items
  • N/A - Not Applicable

Chemicals & Spill Control

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  Media

• Adequate Spill Control & Clean-Up Materials are Available and Well-Marked

  Select 5 - No Deficient Items 4 - 1 Deficient Item 3 - 2 Deficient Items 2 - 3 Deficient Items 1 - 4 or More Deficient Items N/A - Not Applicable

  • 5 - No Deficient Items
  • 4 - 1 Deficient Item
  • 3 - 2 Deficient Items
  • 2 - 3 Deficient Items
  • 1 - 4 or More Deficient Items
  • N/A - Not Applicable

• Stored with Proper Clearance & Away from Incompatibles

  Select 5 - No Deficient Items 4 - 1 Deficient Item 3 - 2 Deficient Items 2 - 3 Deficient Items 1 - 4 or More Deficient Items N/A - Not Applicable

  • 5 - No Deficient Items
  • 4 - 1 Deficient Item
  • 3 - 2 Deficient Items
  • 2 - 3 Deficient Items
  • 1 - 4 or More Deficient Items
  • N/A - Not Applicable

• Proper HazCom/HazMat Label and/or Signage

  Select 5 - No Deficient Items 4 - 1 Deficient Item 3 - 2 Deficient Items 2 - 3 Deficient Items 1 - 4 or More Deficient Items N/A - Not Applicable

  • 5 - No Deficient Items
  • 4 - 1 Deficient Item
  • 3 - 2 Deficient Items
  • 2 - 3 Deficient Items
  • 1 - 4 or More Deficient Items
  • N/A - Not Applicable

• Materials Stored Within Clean Secondary Containment as Required

  Select 5 - No Deficient Items 4 - 1 Deficient Item 3 - 2 Deficient Items 2 - 3 Deficient Items 1 - 4 or More Deficient Items N/A - Not Applicable

  • 5 - No Deficient Items
  • 4 - 1 Deficient Item
  • 3 - 2 Deficient Items
  • 2 - 3 Deficient Items
  • 1 - 4 or More Deficient Items
  • N/A - Not Applicable

Waste Containers

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  Media

• Lids in Place

  Select 5 - No Deficient Items 4 - 1 Deficient Item 3 - 2 Deficient Items 2 - 3 Deficient Items 1 - 4 or More Deficient Items N/A - Not Applicable

  • 5 - No Deficient Items
  • 4 - 1 Deficient Item
  • 3 - 2 Deficient Items
  • 2 - 3 Deficient Items
  • 1 - 4 or More Deficient Items
  • N/A - Not Applicable

• Adequate Number & Location

  Select 5 - No Deficient Items 4 - 1 Deficient Item 3 - 2 Deficient Items 2 - 3 Deficient Items 1 - 4 or More Deficient Items N/A - Not Applicable

  • 5 - No Deficient Items
  • 4 - 1 Deficient Item
  • 3 - 2 Deficient Items
  • 2 - 3 Deficient Items
  • 1 - 4 or More Deficient Items
  • N/A - Not Applicable

• Emptied Regularly

  Select 5 - No Deficient Items 4 - 1 Deficient Item 3 - 2 Deficient Items 2 - 3 Deficient Items 1 - 4 or More Deficient Items N/A - Not Applicable

  • 5 - No Deficient Items
  • 4 - 1 Deficient Item
  • 3 - 2 Deficient Items
  • 2 - 3 Deficient Items
  • 1 - 4 or More Deficient Items
  • N/A - Not Applicable

Non-Housekeeping Items Requiring Attention (DOES NOT COUNT AGAINST SCORE)

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