New Workplace Safety Assessment

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

General Safety and Health

• 1.0 - Have current Injury and Illness Prevention Program (IIPP)?

  Yes

  No

  N/A

• 1.1 - All new employees complete IIPP training and documentation has been verified?

  Yes

  No

  N/A

• 1.2 - Have current Hazard Communication program that includes current GHS changes?

  Yes

  No

  N/A

• 1.3 - All new employees complete HAZCOM/GHS training and documentation has been verified?

  Yes

  No

  N/A

• 1.4 - Have monthly safety meetings that all employees must attend?

  Yes

  No

  N/A

• 1.5 - Monthly safety meeting documentation verified?

  Yes

  No

  N/A

• 1.6 - Have current Personal Protection Equipment (PPE) hazard assessment?

  Yes

  No

  N/A

• Select all required and optional PPE

  Select eye protection face protection dust mask respirator foot protection gloves hard hat cut protection fall protection hearing protection back brace

  • eye protection
  • face protection
  • dust mask
  • respirator
  • foot protection
  • gloves
  • hard hat
  • cut protection
  • fall protection
  • hearing protection
  • back brace

• 1.7 - Have hearing conservation program?

  Yes

  No

  N/A

• 1.8 - Do all affected employees receive hearing conservation training and testing, and documentation has been verified?

  Yes

  No

  N/A

• 1.9 - All employees complete PPE training that is specific to the task they will perform on the job and documentation has been verified?

  Yes

  No

  N/A

• 1.10 - Have current Fall Protection Program?

  Yes

  No

  N/A

• 1.11- All affected employees complete Fall Protection training and documentation has been verified?

  Yes

  No

  N/A

• 1.12 - All affected employees complete safe ladder use training?

  Yes

  No

  N/A

• 1.13 - Have Emergency Evacuation Program and maps are posted?

  Yes

  No

  N/A

• 1.14 - Emergency Evacuation training is completed by all employees and documentation has been verified?

  Yes

  No

  N/A

• 1.15 - Have Lock Out Tag Out (LOTO)Program?

  Yes

  No

  N/A

• 1.16 - All employees complete basic LOTO training and documentation has been verified?

  Yes

  No

  N/A

• 1.17 - Specific employees that perform maintenance, service or equipment repairs complete comprehensive LOTO training and documentation has been verified?

  Yes

  No

  N/A

• 1.18 - Have accident/incident reporting procedures and training is conducted with all employees?

  Yes

  No

  N/A

• 1.19 - Is Material Handling Equipment (MHE) in use?

  Yes

  No

  N/A

• Types of Material Handling Equipment (MHE)?

  Select Class 1 - Electrical Motor Rider Trucks (i.e Sit Down/Stand Up Rider) Class 2 - Electrical Motor Narrow Aisle Trucks (I.e. high lift straddle, order picker, reach type outrigger, side loaders, turret trucks, swings mast and convertible turret/stock pickers, low lift pallet and platform rider) Class 3 - Electrical Motor Hand or Hand/Rider Trucks (I.e. low lift platform, low lift walkie pallet, reach type outrigger, high lift straddle, high lift counterbalanced, low lift walkie/ricer pallet Class 4 - Internal Combustion Engine Trucks (Sit Down, Gas or LPG Class 5 - Internal Combustion Engine Trucks (I.e. sit down rider fork, gas or LPG, Fork, Counterbalanced) Class 7 - Electrical and Internal Combustion Engine Tractor (Straight Mast forklift, Extended Reach Forklift) Gantry/Overhead

  • Class 1 - Electrical Motor Rider Trucks (i.e Sit Down/Stand Up Rider)
  • Class 2 - Electrical Motor Narrow Aisle Trucks (I.e. high lift straddle, order picker, reach type outrigger, side loaders, turret trucks, swings mast and convertible turret/stock pickers, low lift pallet and platform rider)
  • Class 3 - Electrical Motor Hand or Hand/Rider Trucks (I.e. low lift platform, low lift walkie pallet, reach type outrigger, high lift straddle, high lift counterbalanced, low lift walkie/ricer pallet
  • Class 4 - Internal Combustion Engine Trucks (Sit Down, Gas or LPG
  • Class 5 - Internal Combustion Engine Trucks (I.e. sit down rider fork, gas or LPG, Fork, Counterbalanced)
  • Class 7 - Electrical and Internal Combustion Engine Tractor (Straight Mast forklift, Extended Reach Forklift)
  • Gantry/Overhead

• 1.19 (a) - Are Load Weight Capacity Tags Legible?

  Yes

  No

  N/A

• 1.19 (b) - Have Material Handling Equipment (MHE) training and safety program?

  Yes

  No

  N/A

• 1.19 (c) - Are MHE operators trained specifically for the equipment they will be operating and training documentation has been verified?

  Yes

  No

  N/A

• 1.20 - Is Heat Illness Awareness/Prevention Program Required?<br>

  Yes

  No

• 1.20 (a) - Has Training been conducted and Documentation Verified?

  Yes

  No

  N/A

2.0 - Fire Prevention

• 2.1 - Evacuation plan displayed and understood by all employees?

  Yes

  No

  N/A

• 2.2 - Evacuation procedures discussed regularly? (3 to 4 times a year)

  Yes

  No

  N/A

• 2.3 - Extinguishers in place, clearly marked for type of fire?

  Yes

  No

  N/A

• 2.4 - Extinguishers serviced/documented annually?

  Yes

  No

  N/A

• 2.5 Extinguishers inspected/documented monthly?<br>

  Yes

  No

  N/A

• 2.6 - Extinguishers clear of obstructions?

  Yes

  No

  N/A

• 2.7 - Adequate direction notices for fire exits?

  Yes

  No

  N/A

• 2.8 - Exit doors easily opened from inside?

  Yes

  No

  N/A

• 2.9 - Exits clear of obstructions?

  Yes

  No

  N/A

3.0 - General Lighting

• 3.1 - Good natural lighting?

  Yes

  No

  N/A

• 3.2 - Reflected light from walls & ceilings not causing glare to employees?

  Yes

  No

  N/A

• 3.3 - Light fittings clean and in good condition?

  Yes

  No

  N/A

• 3.4 - Emergency exit lighting operable?

  Yes

  No

  N/A

4.0 - Building Safety

• 4.1 - Uneven Floor Surfaces Identified and Marked?

  Yes

  No

  N/A

• 4.2 - Entry and walkways kept clear?

  Yes

  No

  N/A

• 4.3 - Walkways adequately and clearly marked?

  Yes

  No

  N/A

• 4.4 - Intersections kept clear of boxes etc?

  Yes

  No

  N/A

• 4.5 - Stair and risers kept clear?

  Yes

  No

  N/A

• 4.6 - Are liquid spills removed quickly?

  Yes

  No

  N/A

• 4.7 - Are railings in good condition?

  Yes

  No

  N/A

• 4.8 - Are fall preventive measures in place and used where gaps occur in railings?

  Yes

  No

  N/A

• 4.9 - Are footpaths in good condition?

  Yes

  No

  N/A

• 4.10 - Loading area clean and tidy?

  Yes

  No

  N/A

5.0 - Work Benches

• 5.1 - Clear of debris?

  Yes

  No

  N/A

• 5.2 - Tools not in use kept in place?

  Yes

  No

  N/A

• 5.3 - Damaged hand tools taken out of service?

  Yes

  No

  N/A

• 5.4 - Damaged power tools taken out of service?

  Yes

  No

  N/A

• 5.5 - Work height correct for the type of work and the employee?

  Yes

  No

  N/A

• 5.6 - Sharp edges protected or eliminated?

  Yes

  No

  N/A

6.0 - Trash Removal

• 6.1 - Bins located at suitable points around site?

  Yes

  No

  N/A

• 6.2 - Bins emptied regularly?

  Yes

  No

  N/A

• 6.3 - Oily rags and combustible refuse in covered metal containers?

  Yes

  No

  N/A

7.0 - Storage Design and Use

• 7.1 - Materials stored in racks and bins wherever possible?

  Yes

  No

  N/A

• 7.2 - Racks load bearing weight rated and visible?

  Yes

  No

  N/A

• 7.3 - Floors around racking clear of debris?

  Yes

  No

  N/A

• 7.4 - General condition of racks and pallets?

  Yes

  No

  N/A

8.0 - Machines

• 8.1 - Are they kept clean?

  Yes

  No

  N/A

• 8.2 - Are the floors around the machines kept clean?

  Yes

  No

  N/A

• 8.3 - Guards in place and in good condition?

  Yes

  No

  N/A

• 8.4 - Machinery equipped with emergency shut-off and within reach of operator?

  Yes

  No

  N/A

• 8.5 - Waste/off cuts removed and stored safely?

  Yes

  No

  N/A

• 8.6 - Drip pans on floor to prevent spillage?

  Yes

  No

  N/A

• 8.7 - Adequate work space?

  Yes

  No

  N/A

• 8.8 - Is lighting adequate?

  Yes

  No

  N/A

• 8.9 - Noise levels controlled?

  Yes

  No

  N/A

• 8.10 - No bending or stooping required?

  Yes

  No

  N/A

• 8.11 - Operators trained on the specific operation of the machines?

  Yes

  No

  N/A

• 8.12 - Is the training recorded?

  Yes

  No

  N/A

• 8.13 - Do operators comply with the training?

  Yes

  No

  N/A

9.0 - Electrical Safety

• 9.1 - Safety switches installed?

  Yes

  No

  N/A

• 9.2 - Safety switches tested every 6 months and tests documented?

  Yes

  No

  N/A

• 9.3 - No double adapters in use?

  Yes

  No

  N/A

• 9.4 - Portable equipment tested and tagged?

  Yes

  No

  N/A

• 9.5 - No broken plugs, sockets or switches?

  Yes

  No

  N/A

• 9.6 - No flexible cords across walkways?

  Yes

  No

  N/A

• 9.7 - No frayed or damaged flexible cords?

  Yes

  No

  N/A

• 9.8 - No strained cords?

  Yes

  No

  N/A

• 9.9 -Temporary flexible powers used for intended purpose and in good condition?

  Yes

  No

  N/A

• 9.10 - Are all electrical cabinets, junction, switch boxes properly covered and protected?

  Yes

  No

  N/A

10.0 - Chemical Safety

• 10.1 - Hazardous Substance Inventory complete and available?

  Yes

  No

  N/A

• 10.2 - Safety Data Sheets (SDS) available for all chemicals?

  Yes

  No

  N/A

• 10.3 - Risk assessments completed for hazardous substances?

  Yes

  No

  N/A

• 10.4 - All containers labelled correctly?

  Yes

  No

  N/A

• 10.5 - Unused substances disposed of?

  Yes

  No

  N/A

• 10.6 - Do special storage conditions apply?

  Yes

  No

  N/A

• 10.7 - If applicable are special storage conditions followed?

  Yes

  No

  N/A

• 10.8 - Workers trained in the use of hazardous substances?

  Yes

  No

  N/A

• 10.9 - If required is PPE available?

  Yes

  No

  N/A

• 10.10 - Is adequate ventilation provided?

  Yes

  No

  N/A

• 10.11 - Are eye washes and showers easily accessed?

  Yes

  No

  N/A

• 10.12 - Are Eye Was Stations and/or Showers Inspected Tagged & Serviced Accordingly

  Yes

  No

  N/A

11.0 Ladders

• 11.1 - Have Ladder Safety Program and Documented?

  Yes

  No

  N/A

• 11.2 - Are all ladders Industrial strength? (Non Household rated, check label.)

  Yes

  No

  N/A

• 11.3 - Are ladders in good condition?

  Yes

  No

  N/A

• 11.4 - If used for electrical work are they non conductive? (Wood or fibre glass.)

  Yes

  No

  N/A

• 11.5 - Used according to instructions?

  Yes

  No

  N/A

• 11.6 - For extension ladders are ropes, pulleys and treads in a good state of repair?

  Yes

  No

  N/A

• 11.7 - Is comprehensive ladder training documented with all employees required to use ladders?

  Yes

  No

  N/A

• 11.8 - Employees that have not completed ladder training are restricted from ladder use?

  Yes

  No

  N/A

12.0 - First Aid Facilities

• 12.1 - Are cabinets and contents clean and orderly?

  Yes

  No

  N/A

• 12.2 - Are contents regularly checked?

  Yes

  No

  N/A

• 12.3 - Contents past their expiration date discarded?

  Yes

  No

  N/A

• 12.4 - Cabinets clearly labelled?

  Yes

  No

  N/A

• 12.5 - Is there easy access to cabinets?

  Yes

  No

  N/A

• 12.6 - Employees aware of location of first aid cabinet?

  Yes

  No

  N/A

• 12.7 - Are emergency numbers displayed?

  Yes

  No

  N/A

• 12.8 - Is injury reporting contact personnel available?

  Yes

  No

  N/A

13.0 Height Exposures

• 4 Feet or Less

  4 to 15 Feet

  15 to 25 Feet

  25 Feet or Above

• 13.1 Is there scaffolding?

  Yes

  No

  N/A

• 13.2 Scaffolding training for affected employees training conducted & documentation verified?

  Yes

  No

  N/A

• 13.3 Is a designated competent person onsite?

  Yes

  No

  N/A

• 13.4 Are Scissor lifts used by Employees?

  Yes

  No

  N/A

• 13.4 (a) Has the operator been trained and documentation verified?

  Yes

  No

  N/A

• 13.5 Are Articulating Booms used by Employees?

  Yes

  No

  N/A

• 13.5 (a) Has the operator been trained and documentation verified?

  Yes

  No

  N/A

• 13.5 (b) Have affected employees been trained on the proper use of personal fall arrest systems

  Yes

  No

  N/A

• 13.6 Any Catwalk Exposures ?

  Yes

  No

  N/A

• 13.6 (a) Are required fall prevention measures in place?

  Yes

  No

  N/A

14.0 Additional Hazards or Concerns

• 14.1 - Hazard or Concern

  Safe

  At Risk

  N/A

• 14.2 - Hazard or Concern

  Safe

  At Risk

  N/A

• 14.3 - Hazard or Concern

  Safe

  At Risk

  N/A

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