Title Page
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Office location
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Conducted on
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Prepared by
1.0 Walking Surfaces/Housekeeping/General Area
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1.1 The area is tidy and well kept? 29 CFR 1910.141(a)(3)<br>
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1.2 Walkways free of obstacles or obstructions? 29 CFR 1910.22(a)(1)<br>
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1.3 Cords anchored or covered? 29 CFR 1910.22(a)(3)<br>
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1.4 Floor coverings in good condition? 29 CFR 1910.22(a)(3)<br>
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1.5 Signage posted if floors are wet? ANSI Z535-2011 (R2017)<br>
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1.6 The waste container is sufficient and there is no overflowing garbage? 29 CFR 1910.141(a)(3)<br>
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1.7 Work area adequately illuminated? ANSI Standard A11.1-1965, R1970, Practice for Industrial Lighting.<br>
2.0 Bookcases, Shelves & Cabinets
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2.1 Secured from tipping? ANSI/BIFMA X5.5 - 2021<br>
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2.2 In good condition? ANSI/BIFMA X5.5 - 2021<br>
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2.3 Drawers closed when not in use? GOJO Housekeeping policy<br>
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2.4 Material safely stacked and stored? 29 CFR 1910.141(a)(3)<br>
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2.5 Surface dust levels low? 29 CFR 1910.141(a)(3)<br>
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2.6 Material neatly and safely piled? 29 CFR 1910.141(a)(3)<br>
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2.7 Heavier items between knuckle and shoulder height? 29 CFR 1910.141(a)(3)<br>
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2.8 Step stools/ ladder available if needed? 29 CFR 1910.28(b)<br>
3.0 Worker Awareness/Training
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3.1 Workers know how to report an incident or a hazard? GOJO Medical Emergency Situation <br>Contact Procedure<br>
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3.2 Employees aware of security procedures? GOJO Security Policy
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3.3 Employees aware of emergency procedures? GOJO Emergency Evacuation procedure
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3.4 Workers know the evacuation procedure? 29 CFR 1910.38 (f)<br>
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3.5 Employees provided information and instruction regarding hazards? SOP-COR-1017<br>
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3.6 Workers know whom to contact for first aid assistance? GOJO Medical Emergency Situation <br>Contact Procedure
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3.7 Workers know the location of fire extinguishers and how to use them? 29 CFR 1910.157 (g)<br>
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3.8 Workers know location of OSHA workplace safety poster and other work required postings? 29 CFR 1903 (a)(2)<br>
4.0 Fire Prevention
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4.1 Extinguishers available & accessible? 29 CFR 1910.157<br>
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4.2 Extinguishers tag dated monthly? 29 CFR 1910.157 (e) <br>
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4.3 Fire exits clear? 29 CFR 1910.37 (a)(3)<br>
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4.4 Emergency numbers posted in a accessible area? 29 CFR 1910.38 (f)<br>
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4.5 Fire doors closed? 29 CFR 1910.36 (d)<br>
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4.6 Fire exit signs lit? 29 CFR 1910.37 (b)(1)<br>
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4.7 Doors that do not exit the building or lead to an exit labeled "NOT AN EXIT?" 29 CFR 1910.37 (b)(5)<br>
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4.8 Materials stored 18 inches or more from sprinkler heads and ceiling, 24 inches or more if room has no sprinkler heads. 29 CFR 1910.159(c)(10)<br>
5.0 Electrical Safety
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5.1 Electrical Outlets not overloaded? 29 CFR 1910.303(b)(1)<br>
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5.2 Electrical cords in good condition? 29 CFR 1910.334 (a)(2)(II)<br>
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5.3 Grounding pins on plugs are present? 29 CFR 1910.106(e)(6)(ii)<br>
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5.4 Access to electrical panels is clear and unobstructed? NFPA 70-2011 Article 110.26 1910.301-308<br>
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5.5 Breakers in the electrical panel properly labelled and legible? 29 CFR 1910.303(f)(1)<br>
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5.6 Are all cables in good repair, no frayed wires or cables? 29 CFR 1910.334 (a)(2)(II)<br>
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5.7 GFCI pass first test using push buttons built into the outlet receptacle by sinks/water access points NFPA 70, NEC<br>
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5.8 Extension cords are not used as replacement of permanent wiring? 29 CFR 1910.305(a)(2)<br>
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5.9 Electrical cords secure? 29 CFR 1910.334 (a)(2)(II)<br>
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5.10 Are there any "Daisy Chained" power strips or extension cords? 29 CFR 1910.305(a)(2)<br>
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5.11 Faulty equipment is tagged out? 29 CFR 1910.334 (a)(2)(II)<br>
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5.12 Electrical faceplates in place? Electrical panel and junction box knockouts in place? 29 CFR 1910.303(b)(1)<br>
6.0 First Aid
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6.1 First aid cabinets checked weekly? 29 CFR 1910.151<br>
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6.2 List of First Aid responders posted and current? GOJO medical Emergency Situation <br>Contact Procedure<br>
7.0 Ergonomics
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7.1 Chairs fully adjustable (seat and back)? NIOSH MSD Health Program<br>
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7.2 Monitors adjusted to the right height (Top of the screen should be at eye level)? NIOSH MSD Health Program<br>
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7.3 Workstation ergonomically correct? NIOSH MSD Health Program<br>
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7.4 Shoulders relaxed and forearms parallel with keyboard? NIOSH MSD Health Program<br>
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7.5 Chairs are set-up so that the thighs are parallel to the floor? NIOSH MSD Health Program<br>
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7.6 Are frequently used items located within the person’s primary zone? NIOSH MSD Health Program<br>
Completion
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Any other observations or recommendations
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Full Name and Signature of the Inspector
