Montana Department of Transportation Workplace Safety Checklist

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Housekeeping

• Are passageways, storerooms, service rooms, and storage sheds kept clean, orderly and sanitary?

  Yes

  No

  N/A

• Are work rooms and work areas maintained in a clean and, so far as possible, dry condition with drains maintained where wet processes are used?

  Yes

  No

  N/A

• Are floors, working places, and passage ways kept free of protruding nails, splinters, holes or loose boards?

  Yes

  No

  N/A

• Are aisles and passageways, kept clear and in good repair, with no obstruction across or with aisles that could create a hazard?

  Yes

  No

  N/A

• Are trash containers emptied on a daily basis?

  Yes

  No

  N/A

• Are wash rooms clean and sanitary?

  Yes

  No

  N/A

Electrical

• Are all outlets in good working condition and wired properly when tested with a circuit tester?

  Yes

  No

  N/A

• Do all areas have the appropriate type of outlets? (I.e. GFCI, weatherproof in wet areas, ect.)

  Yes

  No

  N/A

• Do all panel boxes have proper labels, have covers on them and are free of obstructions?

  Yes

  No

  N/A

• Are all extension cords being used properly and not in lieu of permanent wiring?

  Yes

  No

  N/A

• Are all extension cords free from worn and damage insulation, wired properly and have male and female connections in good working order?

  Yes

  No

  N/A

• Are all trouble lights of an approved type that are intrinsically safe?

  Yes

  No

  N/A

Fire extinguishers

• Are portable fire extinguishers mounted, located and identified so that they are readily accessible?

  Yes

  No

  N/A

• Are fire extinguishers of proper size, maintained in a fully charged and operable condition and kept in their designated places?

  Yes

  No

  N/A

• Have portable fire extinguishes been serviced annually and inspected monthly, with monthly inspections documented on attached tag?

  Yes

  No

  N/A

Tools

• Are all power tools having power cords in good condition and free from any recognized hazards?

  Yes

  No

  N/A

• Are all power tool guards in place and in good working condition?

  Yes

  No

  N/A

• Do all floor stand and bench grinders have the tongue guard adjusted it within 1/4 inch and the work rest adjusted to within 1/8 inch clearance from the wheel?

  Yes

  No

  N/A

• Are all hand tools in good working condition?

  Yes

  No

  N/A

Personal Protective Equipment

• Is PPE for eyes, face, head ad extremities, protective clothing, respiratory devices, and protective shields and barriers, provided, used, and maintained in a sanitary and reliable condition?

  Yes

  No

  N/A

• Is employee-owned PPE properly maintained and in sanitary condition?

  Yes

  No

  N/A

• Is PPE appropriate for the work being performed?

  Yes

  No

  N/A

• Is PPE free of any defects and damage?

  Yes

  No

  N/A

Equipment

• Have the air compressor receivers been drained monthly and documented on attached tag?

  Yes

  No

  N/A

• Are all nozzle attachments rated at 30 psi or less?

  Yes

  No

  N/A

• Are all pressure gauges in working condition and free of any defects?

  Yes

  No

  N/A

• Are power cords on all equipment free from hazards?

  Yes

  No

  N/A

• Do all floor jacks have rated loads marked on them in a conspicuous place?

  Yes

  No

  N/A

• Are all chains/cables/shafts free from recognized hazards?

  Yes

  No

  N/A

Medical

• Do first aid kits have clean sterile supplies and are they readily available?

  Yes

  No

  N/A

• Does the emergency eye wash station have an operable water supply?

  Yes

  No

  N/A

• Has the emergency eye wash station been flushed on a weekly basis and documented on an attached tag?

  Yes

  No

  N/A

• Is the emergency eye wash station free from obstructions?

  Yes

  No

  N/A

Stairways and Ladders

• Are standard railings provided on the open side of all exposed stairways and stair platforms?

  Yes

  No

  N/A

• Are all ladders free of broken or missing steps, rungs or cleats; broken side rails; sharp edges and splinters; and other identifiable defects?

  Yes

  No

  N/A

• Are ladder maintained in good usable condition at all times and are repairs safe and not improvised?

  Yes

  No

  N/A

• Are fixed ladders maintained in a safe condition? Are fixed ladders inspected regularly and the intervals between inspections being determined by use and exposure?

  Yes

  No

  N/A

• Are fixed ladders painted or otherwise treated to resist corrosion and rusting?

  Yes

  No

  N/A

• Do lost areas have standard toe boards to prevents objects from falling below?

  Yes

  No

  N/A

Hazard Communication

• Is the MSDS binder in a location that is easily accessible and identifiable by everyone?

  Yes

  No

  N/A

• Does the MSDS binder contains all of the needed sheets, properly indexed and contain a copy of the written Hazard Communication Plan?

  Yes

  No

  N/A

• Are all tanks and drums properly labeled with placards?

  Yes

  No

  N/A

• Are all containers labeled identifying the contents and hazards of the material contained within?

  Yes

  No

  N/A

Flammable and Combustable Material

• Are flammable or combustible liquids stored in tanks or closed containers and precautions taken for possible spills and leaks?

  Yes

  No

  N/A

• Does the fuel dispensing station have a clearly defined and easily accessible emergency shutoff device location not less than 25 feet and not more than 75 feet from the dispensing area?

  Yes

  No

  N/A

• Are flammable or combustible tanks or vaults suitably protected from a vehicle collision damage?

  Yes

  No

  N/A

• Are areas used for flammable and combustible storage posted with the proper signs and precautions?

  Yes

  No

  N/A

• Are readily ignitable material such as weeds and long dry grass removed from with in 10 feet of any flammable or combustible tank or vault?

  Yes

  No

  N/A

• Are all liquified petroleum gas and flammable liquid containers stored at least 20 feet apart?

  Yes

  No

  N/A

• If refilling of small propane cylinders occurs, are employees trained in the proper procedure?

  Yes

  No

  N/A

• Are compressed gas and propane cylinders kept upright, secured by chain or strap at least 1/3 the height of the cylinder, and stored in a manner to minimize excessive temperature rise, physical damage, or tampering by unauthorized person?

  Yes

  No

  N/A

• Are compressed gas and propane cylinders stored inside located away from exits, stairways, or in areas normally used or intended for safe exit of people?

  Yes

  No

  N/A

• Are compressed gas and propane cylinders valves protected while in storage by a ventilated cap or collar that is fastened to the container capable of withstanding a blow from any direction?

  Yes

  No

  N/A

• Have propane cylinders been re-qualified when they are 12 years old and every 5 years following?

  Yes

  No

  N/A

• Are shop rags that are oily or greasy stored in metal or metal lined containers equipped with tight fitting covers?

  Yes

  No

  N/A

• Are compressed gas cylinders stored at least 20 feet away from highly combustible material?

  Yes

  No

  N/A

• Is the parts washer protected by and automatic closure system in the event of a fire?

  Yes

  No

  N/A

• Are all portable flammable liquid cans metal and not plastic?

  Yes

  No

  N/A

Vehicles and Heavy Equipment

• Are all safety and warning devices in operating condition?

  Yes

  No

  N/A

• Are all lights and visual warning devices in operating conditions?

  Yes

  No

  N/A

• Are all vehicles equipped with safety devices being used?

  Yes

  No

  N/A

• Are all vehicles and heavy equipment being maintained and inspected?

  Yes

  No

  N/A

Building Exterior

• Are building exteriors free from weeds, grass and vegitation?

  Yes

  No

  N/A

• Are the building themselves free from damage?

  Yes

  No

  N/A

• Is the yard area being maintained in an orderly manner and free from hazard?

  Yes

  No

  N/A

Miscellaneous

• Are there any hazards or safety and health issues that have not been addressed in the above categories?

  Yes

  No

  N/A

Approval

• Do you confirm that this audit was completed in your presence or in the presence of an authorized representative?

  Yes

  No

  N/A

• Name of authorized representative

Signature

• Section Manager or Authorized Representative

  Sign

• Safety Consultant

  Sign