Manufacturing & Distribution Jobsite Safety Checklist

• Client / Site

• Date:

  Date

• Branch #:

• Assessed By:

• Name of Company/Address:
  Address

• Client Representative/Title:

• Staffing Representative:

• Number of Temporary Staff at Location:

• Number of Regular Staff at Location:

• Shift(s) and Hours:

• Essential Duties and Responsibilities:

• EXMOD

• W/C CODES

• RATE

• OSHA VIOLATIONS

  Yes

  No

  N/A

1. Accident/Injury Management Information

• Do you have a COVID-19 Prevention Program

  Yes

  No

  N/A

• Injury and Illness Prevention Program in place?

  Yes

  No

  N/A

• OSHA log maintained?

  Yes

  No

  N/A

• Client notified to report recordable injuries on OSHA 300 log?

  Yes

  No

  N/A

• Modified duty available to contingent workforce per physician’s guidelines?

  Yes

  No

  N/A

• Client is aware of Eastridge injury Protocol?

  Yes

  No

  N/A

• Comments:

2. Training – Check all that Apply

• Safety orientation?

  Yes

  No

  N/A

• Provided by:

• Job-specific training?

  Yes

  No

  N/A

• Recordkeeping maintained on safety orientation and job-specific trainings?

  Yes

  No

  N/A

• Safety committee meets regularly?

  Yes

  No

  N/A

• Frequency:

• Do you have a Workplace Violence Prevent Plan

  Yes

  No

  N/A

• Do you provide WVPP training for Temp Staff

  Yes

  No

  N/A

• System for identifying and evaluating hazards?

  Yes

  No

  N/A

• Comments:

3. Personal Protective Equipment

• List types required (e.g., goggles, gloves, hardhat, earplugs, face shields, etc.):

• Providedby:

  Client

  EastridgeWorkforceSolutions

  Notrequired

• Hearing conservation program implemented?

  Client

  EastridgeWorkforceSolutions

  Notrequired

• Written respiratory protection program implemented?

  Yes

  No

  N/A

• PPE is Latex-free?

  Yes

  No

  N/A

• Comments:

4. Walking/Working Surfaces

• Documented, functioning housekeeping program in place?

  Yes

  No

  N/A

• Exits, aisles, passageways and walkways free of obstruction and marked appropriately?

  Yes

  No

  N/A

• Proper and safe storage of materials?

  Yes

  No

  N/A

• Fall safety protection program in place? (i.e., safety harness.)

  Yes

  No

  N/A

• Non-work areas are free of slip, trip and fall hazards?

  Yes

  No

  N/A

• Comments:

5. Fire Protection

• Fire extinguishing equipment, hoses, and sprinklers regularly inspected?

  Yes

  No

  N/A

• Exit routes free and unobstructed?

  Yes

  No

  N/A

• Annual fire drill performed?

  Yes

  No

  N/A

• Evacuation and emergency plans posted?

  Yes

  No

  N/A

• Comments:

6. Machinery and Safe Guarding

• Contingent employees using machines on site to perform their duties?

  Yes

  No

  N/A

• Safeguards prevent employees’ body parts from making contact with moving parts?

  Yes

  No

  N/A

• Inspections and regular service performed on machines?

  Yes

  No

  N/A

• Machines have a red emergency shut-off button within reach of operator?

  Yes

  No

  N/A

• Comments:

7. Tools and Equipment

• Proper use (power tools, hand tools, ladders)

  Yes

  No

  N/A

• Tools are in good working condition?

  Yes

  No

  N/A

• Industrial knives have safety features (auto-retractable, hook-style, etc.)?

  Yes

  No

  N/A

• Comments:

8. Ergonomics

• Measures taken to safeguard workers against ergonomic hazards?

  Yes

  No

  N/A

• Job requires repetitive motion?

  Yes

  No

  N/A

• Choose one.

  Yes

  No

  N/A

• Tasks are:

  Select Gripping Grasping Overhead Lifting Fine Movement

  • Gripping
  • Grasping
  • Overhead
  • Lifting
  • Fine Movement

• Body part affected: (hands, wrists, elbows, knees, back, etc.) Bending, stooping, twisting motions, pushing, pulling, reaching motions.

  Yes

  No

  N/A

• Other factors: vibration, temperature, sound, etc.

  Yes

  No

  N/A

• Are workstations adjustable?

  Yes

  No

  N/A

• Stretch and Flex program in place?

  Yes

  No

  N/A

• Comments:

9. Lock-out/Tag-out

• Contingent employees perform Lock-out/Tag-out?

  Yes

  No

  N/A

• Machinery or equipment capable of movement required to be de-energized or disengaged and locked out during cleaning, servicing, adjusting or setting up operations, whenever required?

  Yes

  No

  N/A

• Sufficient number of accident prevention signs or tags and safety padlocks provided for any reasonable and foreseeable repair emergency?

  Yes

  No

  N/A

• Comments:

10. Contact Agents - Health Hazards - Locked Chemicals

• Chemicals labeled and stored properly?

  Yes

  No

  N/A

• SDS (Safety Data Sheets) accessible and properly maintained?

  Yes

  No

  N/A

• Airborne contaminants? (i.e., dust, fumes, vapors.)

  Yes

  No

  N/A

• Are controls and/or PPE in place to eliminate employee exposure to hazardous chemicals?

  Yes

  No

  N/A

• Will employees be exposed to allergens (Nuts, wheat, fish, etc.)?

  Yes

  No

  N/A

• Comments:

11. Electrical

• Does the power supply to machinery appear to be in good working condition?

  Yes

  No

  N/A

• Any power cords damaged, deteriorated or suffering from strain relief?

  Yes

  No

  N/A

• Power cords or extension cords create a potential trip, slip, or fall hazard for employees?

  Yes

  No

  N/A

• All Electrical panels have a clear area of 36 inches by 36 inches?

  Yes

  No

  N/A

• Electrical outlets, junction boxes and other electrical components properly covered?

  Yes

  No

  N/A

• Comments:

12. Material Handling

• Contingent workers using Powered Industrial Equipment?

  Yes

  No

  N/A

• Contingent employee certified at client’s site?

  Yes

  No

  N/A

• Powered Industrial Trucks inspected on a daily basis?

  Yes

  No

  N/A

• Conveyors guarded, including belts, gears, sprockets, chains and screws?

  Yes

  No

  N/A

• Conveyor emergency cable stop accessible to employees?

  Yes

  No

  N/A

• Any hoists onsite using cables, ropes, chains, or vacuum systems?

  Yes

  No

  N/A

• Inspections and regular service performed on hoisting equipment?

  Yes

  No

  N/A

• Eyewash station within 10 seconds of forklift charging area and serviced regularly?

  Yes

  No

  N/A

• Propane tanks stored in an approved cage 20 feet from emergency exits and ignition sources?

  Yes

  No

  N/A

• Pallet stacks are no more than 6 feet high and separated by 8 feet?

  Yes

  No

  N/A

• Wheels are chocked/blocked prior to entering truck/trailer?

  Yes

  No

  N/A

• Types(s) of Powered Industrial Truck(s) onsite:

• Comments:

13. Confined Spaces

• Any work areas which are considered Confined Space?

  Yes

  No

  N/A

• Contingent employees enter or work around Confined Spaces?

  Yes

  No

  N/A

• Provide all necessary equipment (testing, ventilation, PPE, etc.)

  Yes

  No

  N/A

• Emergency action and rescue plan?

  Yes

  No

  N/A

• Comments:

• Client/Prospect approved for staffing?

  Yes

  No

  N/A

• Photos available?

  Yes

  No

  N/A

• Follow up Tour Required?

  Yes

  No

  N/A

• Corrective Measures Suggested:

• EH&S Manager/Branch Representative:

  Sign

• Is client's signature required?

  Yes

  No

  N/A

• Client Signature

  Sign

• The OSHA guidelines for the contingent workforce impose certain responsibilities for Eastridge Workforce Solutions and its clients in order to ensure a safe and healthy work environment. We look forward to working together in compliance with these guidelines.
  
  Please return the reviewed and signed document with photographs (if applicable) to: allsafety@eastridge.com