MDLZ

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

SAFETY SCAN PURPOSE: TO ENCOURAGE LEADERS TO BE MORE VISIBLY ACTIVE IN SAFETY AND NOTE SAFE AND UNSAFE PRACTICES.

1. A safety scan should take 10-15 minutes in a finite area. 2. List the positive and improvement opportunities found. 3. Develop corrective action and recognition. 4. Track follow-up action until completion (recognition or corrective action) 5. Retain scans for 6 months.

Observation: Note positive actions, good housekeeping, and give instant feedback. Do not put down name of employees being observed. Note unsafe actions/conditions, corrective actions taken and document follow-up actions. Verbally recognize workers, training, work order, etc.

• Observations Notes:

  Safe

  At Risk

  N/A

Housekeeping

• Is the location clean and orderly?

  Yes

  No

  N/A

• Are there any tripping hazards that need to be fixed?

  Yes

  No

  N/A

Loading Pallets

• Is the employee using proper material handling techniques?

  Yes

  No

  N/A

Pick LIne

• Is proper material handling being utilized?

  Yes

  No

  N/A

• Are pallets stacked too high to reach?

  Yes

  No

  N/A

Stretching

• Have you done your pre-shift stretching today?

  Yes

  No

  N/A

Drivers

• Are 3 points of contact being used when entering and exiting the truck?

  Yes

  No

  N/A

• Are proper lifting techniques being used?

  Yes

  No

  N/A

• Are proper driver methods being used?

  Yes

  No

  N/A

• Are truck wheels chocked

  Yes

  No

  N/A

Forklift

• Are pre-shift inspections being completed?

  Yes

  No

  N/A

• Is the employee wearing the seatbelt? Give instant feedback (positive or negative)

  Yes

  No

  N/A

• Is the forklift operator driving in a safe manner?

  Yes

  No

  N/A

• Is the forklift driver using a horn?

  Yes

  No

  N/A

Dock Loading/Unloading

• Is the proper dock loading/unloading procedure being used? Check key control, doors closed when not loading, etc.

  Yes

  No

  N/A

Training

• Do you feel you have received sufficient safety training for your job?

  Yes

  No

  N/A

General Questions to Ask

• How would you evacuate in an emergency?

  Yes

  No

  N/A

• Do you have any suggestions to make this branch a safer place to work?

  Yes

  No

  N/A

• What are you personally working on to improve your safety and that of your co-workers?

  Yes

  No

  N/A

RESULTS

• Number of deficiencies noted:

  Yes

  No

  N/A

• Number of positive actions:

  Yes

  No

  N/A

• Number of employee interactions

  Yes

  No

  N/A

SPECIFIC OBSERVATION ISSUES

• Note what you observed:

  Yes

  No

  N/A

• Provide information on the instant feedback given to the employee (positive and improvement requirements):

  Yes

  No

  N/A

• What will the employee be working on to improve?

  Yes

  No

  N/A