Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Department audited

Department audit

  • Are all emergency exits free of obstruction and identified with signage?

  • Are eye wash stations present, in good condition, clear of obstruction, and stocked?

  • Are fire extinguishers present, marked with a sign, clear of obstruction, and inspected in the last month?

  • Is additional PPE required in the working area?

  • What PPE is required in the area? (check all that apply)

  • Are all associates wearing the PPE that is required?

  • Does PPE have designated storage area, and in good condition?

  • Is there machinery in the working area?

  • Are guards in place and secured in two locations to prevent interaction with moving parts?

  • Is there adequate lockout devices available to associates?

  • Is there cleaning or maintenance being performed on the equipment?

  • Do all associates performing work have their lock applied to the lockout point?

  • Are pre-use inspections completed on all machinery and vehicles? (ex: forklifts, tuggers, power jacks, headfiller, packing lines, winches, blending line)

  • Are ladders in good condition, and free of any defects or adjustments? (ex: no twists in rails, no cracks in fiberglass, no bent steps)

  • Are there any electrical hazards in the area? (ex: water coming in contact with panels, panels don't have 3ft. clearance, exposed wiring)

  • Is the working area free of slip/trip hazards?

  • Are there any hazards present on around the perimeter of the building (ex: parking lots, driveways, walkways)

Sign Off

  • Person completing report

  • Signature of person completing report

  • Signature of person completing report

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.