Title Page
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Site conducted
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Conducted on
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Prepared by
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Department audited
Department audit
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Are all emergency exits free of obstruction and identified with signage?
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Are eye wash stations present, in good condition, clear of obstruction, and stocked?
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Are fire extinguishers present, marked with a sign, clear of obstruction, and inspected in the last month?
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Is additional PPE required in the working area?
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What PPE is required in the area? (check all that apply)
- Bumpcap
- Hard hat
- Hi-vis
- Seatbelts (operating vehicles)
- 5 point harness
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Are all associates wearing the PPE that is required?
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Does PPE have designated storage area, and in good condition?
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Is there machinery in the working area?
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Are guards in place and secured in two locations to prevent interaction with moving parts?
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Is there adequate lockout devices available to associates?
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Is there cleaning or maintenance being performed on the equipment?
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Do all associates performing work have their lock applied to the lockout point?
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Are pre-use inspections completed on all machinery and vehicles? (ex: forklifts, tuggers, power jacks, headfiller, packing lines, winches, blending line)
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Are ladders in good condition, and free of any defects or adjustments? (ex: no twists in rails, no cracks in fiberglass, no bent steps)
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Are there any electrical hazards in the area? (ex: water coming in contact with panels, panels don't have 3ft. clearance, exposed wiring)
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Is the working area free of slip/trip hazards?
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Are there any hazards present on around the perimeter of the building (ex: parking lots, driveways, walkways)
Sign Off
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Person completing report
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Signature of person completing report
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Signature of person completing report