Information
-
Document No.
-
Client / Site
-
Conducted on
-
Prepared by
-
Location
-
Number of Personnel
Ergonomics - Body Posture
-
Lifting/Bending in the strike zone (thigh to chest levels)
-
Reaching/Twisting (reaching low and to the side -- stretching up and to the side)
-
Pushing/Pulling (push good - pull bad)
-
Posture (back, arm, head, shoulders, and truck straight?)
-
Awkward posture sustained (more than 5 seconds before relaxing?)
-
Two person lift used (material over 50lbs or bulk items)
-
F - Use of seatbelt
-
G- proper use of forks (secured loads, used for lifting or transporting only)
-
H- Proper use of chokers, clamps, chains, etc..
-
Misc. Notes
-
Misc. Picture
Behavioral Observations
-
Unsafe behaviors observed - Actions taken to correct & prevent reoccurrence
-
Safe behaviors observed - Actions taken to encourage safe behavior
Work Environment
Work Environment
-
Weather temperature?
-
Wind speed?
-
Furniture & chairs are in good stable condition
-
Work Areas:Clean, sanitary, & orderly
-
Items stored properly to avoid tripping & falling
-
Debris and scrap stored safely
-
PPE is readily available and well maintained
-
Areas requiring PPE have adequate warning signs posted , and usage is enforced
-
Work area is adequately illuminated <br><br>
-
Aisles and passageways are clear
-
Material Storage - Sharp projections do not interfere with the walkways
-
All aisles maintain a safe clearance (3 feet minimum)
-
Job trailer areas maintained outside
-
Hot work areas free of combustibles and flammables (35 feet/ fire blankets?)
-
Are all exits free of obstructions
Equipment
-
Ladders are in good condition (no cracks, damage to rungs, rails, braces, steps, etc..)
-
All tools & equipment are in good working condition (corded devices have no frayed or exposed wires)
Chemicals
-
All chemicals are clearly marked & labeled
-
Appropriate PPE (when applicable) provided, used, & maintained
First Aid
-
First aid kits are wall mounted, fully stocked & clearly marked
-
Emergency Eye wash station is properly maintained & inspected (check date on saline solution)