Title Page

  • Conducted on

  • Prepared by

  • Location

Emergency Equipment/Egress

  • Are electrical panels, eyewash<br>stations, spill clean up equipment, first aid<br>cabinets, exit doors & pathways accessible and free from obstruction?

  • Are Fire extinguisher in place and inspected, not<br>blocked

  • Safety light work correctly- Perform check

  • Is there Evacuation plan posted (EAP)?

Personal Protective Equipment

  • Is required PPE accessible in department

  • Proper PPE worn by all employees: gloves, ear<br>protection, face shields, Glasses, special<br>equipment required by job ( When Required)

Hazardous Materials

  • Flammable/combustible materials stored properly;<br>lids closed, used rags in containers

  • Flammables grounded when transferred to other containers?

  • Secondary containers labeled

  • Food grade and non-Food Grade chemicals<br>separated

General

  • Hand tools properly stored, used & in good<br>condition

  • Barrier guards in place.

  • Shelving/mezzanines marked for capacity

  • Compressed gas cylinders properly stored

  • ladders in good condition

  • Fall protection required?

Housekeeping

  • Hoses put away when not in use

  • Aisles/work areas properly lit

  • Walkways free of debris; cardboard, scrap, parts,<br>spider webs present, no leaning pallets etc.

  • Master Cleaning Schedule Up To Date

Lockout Procedure

  • Machine specific procedures posted on all<br>required equipment (SOP)

  • Provisions for lockout provided on all machines

  • Employees knowledgeable of requirements for<br>affected employee: cannot start equipment,<br>cannot help with service, cannot remove lock (Please speak with workers in that area)

Machine Guarding

  • Any damaged guarding

  • Equipment guards in place & used

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.