Information
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Document No.
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Area Inspected
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Conducted on
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Auditor Name:
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Auditor Signature:
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Are all machine guards in place?
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Deficiencies & Corrective Actions
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Tools (knives/scissors) in good conditions & properly staged or stored?
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Deficiencies & Corrective Actions
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Are all drain covers in place?
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Deficiencies & Corrective Actions
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Are the Stairs, Railings, and Guardrails in good conditions?
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Deficiencies & Corrective Actions
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Are all Conveyors/Augers operating in a safe condition?
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Deficiencies & Corrective Actions
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Are all equipment switches and disconnects intact, operational and in good repair?
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Deficiencies & Corrective Actions
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Are all emergency stop buttons/controls working?
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Deficiencies & Corrective Actions
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Are all Saws/Power Equipment operating in a safe condition?
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Deficiencies & Corrective Actions
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Do all outlets have a self closing cover with rubber gasket?
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Deficiencies & Corrective Actions
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Are any S/O cords wrapped around any conductive material?
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Deficiencies & Corrective Actions
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Are all limit/proximity switches working?
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Deficiencies & Corrective Actions
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Are all egress routes unobstructed?
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Deficiencies & Corrective Actions
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Does all emergency and exit lighting work?
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Deficiencies & Corrective Actions
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Are all fire extinguishers in place and fully charged?
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Deficiencies & Corrective Actions
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Are all eyewash/drench showers in place and in good repair?
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Deficiencies & Corrective Actions
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Are all control/electrical panels closed and latched?
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Deficiencies & Corrective Actions
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Are employee work stations in good repair and properly setup?
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Deficiencies & Corrective Actions
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Housekeeping acceptable?
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Deficiencies & Corrective Actions
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Any other unsafe conditions which may pose a hazard to our employees?
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Deficiencies & Corrective Actions
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Please list any employee safety concerns, unsafe acts, or ergonomic issues in the spaces below and the corrective action taken in the spaces below.
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Area Supervisor Name:
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Area Supervisor Signature:
