MOD Audit

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

Floor 1

• Is there any grating that is missing?

  Yes

  No

  N/A

• Are any areas blocked?

  Yes

  No

  N/A

• Rate the Cleanliness of this floor

  Select Great Good Fair Poor-Safety Hazard Bad-Safety Hazard N/A

  • Great
  • Good
  • Fair
  • Poor-Safety Hazard
  • Bad-Safety Hazard
  • N/A

Floor 2

• Is there any grating that is missing?

  Yes

  No

  N/A

• Are any areas blocked?

  Yes

  No

  N/A

• Rate the Cleanliness of this floor

  Select Great Good Fair Poor-Safety Hazard Bad-Safety Hazard N/A

  • Great
  • Good
  • Fair
  • Poor-Safety Hazard
  • Bad-Safety Hazard
  • N/A

Floor 3

• Is there any grating that is missing?

  Yes

  No

  N/A

• Are any areas blocked?

  Yes

  No

  N/A

• Rate the Cleanliness of this floor

  Select Great Good Fair Poor-Safety Hazard Bad-Safety Hazard N/A

  • Great
  • Good
  • Fair
  • Poor-Safety Hazard
  • Bad-Safety Hazard
  • N/A

Fall Protection

• Does this mod have fall protection in place in levels 2 & 3?

  Yes

  No

  N/A

• Are the fall protection signs abundant and easy to see?

  Yes

  No

  N/A

Pallet Stoppers

• Are all pallet stoppers in place and in good condition?

  Yes

  No

  N/A

Floor 1

• Is there any grating that is missing?

  Yes

  No

  N/A

• Are any areas blocked?

  Yes

  No

  N/A

• Rate the Cleanliness of this floor

  Select Great Good Fair Poor-Safety Hazard Bad-Safety Hazard N/A

  • Great
  • Good
  • Fair
  • Poor-Safety Hazard
  • Bad-Safety Hazard
  • N/A

floor 2

• Is there any grating that is missing?

  Yes

  No

  N/A

• Are any areas blocked?

  Yes

  No

  N/A

• Rate the Cleanliness of this floor

  Select Great Good Fair Poor-Safety Hazard Bad-Safety Hazard N/A

  • Great
  • Good
  • Fair
  • Poor-Safety Hazard
  • Bad-Safety Hazard
  • N/A

Floor 3

• Is there any grating that is missing?

  Yes

  No

  N/A

• Are any areas blocked?

  Yes

  No

  N/A

• Rate the Cleanliness of this floor

  Select Great Good Fair Poor-Safety Hazard Bad-Safety Hazard N/A

  • Great
  • Good
  • Fair
  • Poor-Safety Hazard
  • Bad-Safety Hazard
  • N/A

Fall Protection

• Does this mod have fall protection in place in levels 2 & 3?

  Yes

  No

  N/A

• Are the fall protection signs abundant and easy to see?

  Yes

  No

  N/A

Pallet Stoppers

• Are all pallet stoppers in place and in good condition?

  Yes

  No

  N/A

Floor 1

• Is there any grating that is missing?

  Yes

  No

  N/A

• Are any areas blocked?

  Yes

  No

  N/A

• Rate the Cleanliness of this floor

  Select Great Good Fair Poor-Safety Hazard Bad-Safety Hazard N/A

  • Great
  • Good
  • Fair
  • Poor-Safety Hazard
  • Bad-Safety Hazard
  • N/A

Floor 2

• Is there any grating that is missing?

  Yes

  No

  N/A

• Are any areas blocked?

  Yes

  No

  N/A

• Rate the Cleanliness of this floor

  Select Great Good Fair Poor-Safety Hazard Bad-Safety Hazard N/A

  • Great
  • Good
  • Fair
  • Poor-Safety Hazard
  • Bad-Safety Hazard
  • N/A

Floor 3

• Is there any grating that is missing?

  Yes

  No

  N/A

• Are any areas blocked?

  Yes

  No

  N/A

• Rate the Cleanliness of this floor

  Select Great Good Fair Poor-Safety Hazard Bad-Safety Hazard N/A

  • Great
  • Good
  • Fair
  • Poor-Safety Hazard
  • Bad-Safety Hazard
  • N/A

Floor 4

• Is there any grating that is missing?

  Yes

  No

  N/A

• Are any areas blocked?

  Yes

  No

  N/A

• Rate the Cleanliness of this floor

  Select Great Good Fair Poor-Safety Hazard Bad-Safety Hazard N/A

  • Great
  • Good
  • Fair
  • Poor-Safety Hazard
  • Bad-Safety Hazard
  • N/A

Fall Protection

• Does this mod have fall protection in place in levels 2 & 3 & 4?

  Yes

  No

  N/A

• Are the fall protection signs abundant and easy to see?

  Yes

  No

  N/A

Pallet Stoppers

• Are all pallet stoppers in place and in good condition?

  Yes

  No

  N/A

• Where shepherds hooks easy to find? (visible)

  Yes

  No

  N/A

• Anything else to add regarding this MOD Audit?

  Yes

  No

  N/A