Title Page

  • Inspection Date

  • Auditor

  • Employees Involved

  • Department

Safety Gemba

Do employee's know?

  • Do employee's know what to do if there is LOTO equipment on the machine?

  • Do employees know where their assembly area is during an evacuation?

  • Do employees know where to find the emergency evacuation map?

  • Do employees know where to get new PPE?

  • Do employees know where to find Safety Data Sheets (SDS)?

Machine Guarding/Lockout Tagout

  • Equipment is adequately guarded to ensure employees cannot access during operation.

  • Are LOTO machine procedures available and updated for the current year?

Emergency Evacuation / Fire Prevention

  • Are fire extinguishers up-to-date on monthly inspections?

  • Are electrical panels clear of storage (36")?

  • Are fire extinguishers hung and unblocked (36")?

  • Are exit doors and routes unblocked, accessible, and unobstructed?

  • Are aisleways clear of materials and debris?

Personal Protection Equipment (PPE)

  • Are PPE charts updated for the current year?

  • Are employees wearing all required PPE while performing job task?

Hazard Communication (HazCom)

  • Are all secondary containers labeled correctly?

  • All chemical/oil/coolant containers on secondary containments?

  • Waste drums properly labeled with contents?

Ergonomics

  • Are employees lifting with proper ergonomic techniques?

  • Are the wheels on the bins in good condition?

  • Are tools in good condition?

Completion

  • Overall Comments

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.