• Are all machine guards in place?

  • Deficiencies & Corrective Actions

  • Tools (knives/scissors) in good conditions & properly staged or stored?

  • Deficiencies & Corrective Actions

  • Are all drain covers in place?

  • Deficiencies & Corrective Actions

  • Are the Stairs, Railings, and Guardrails in good conditions?

  • Deficiencies & Corrective Actions

  • Are all Conveyors/Augers operating in a safe condition?

  • Deficiencies & Corrective Actions

  • Are all equipment switches and disconnects intact, operational and in good repair?

  • Deficiencies & Corrective Actions

  • Are all emergency stop buttons/controls working?

  • Deficiencies & Corrective Actions

  • Are all Saws/Power Equipment operating in a safe condition?

  • Deficiencies & Corrective Actions

  • Do all outlets have a self closing cover with rubber gasket?

  • Deficiencies & Corrective Actions

  • Are any S/O cords wrapped around any conductive material?

  • Deficiencies & Corrective Actions

  • Are all limit/proximity switches working?

  • Deficiencies & Corrective Actions

  • Are all egress routes unobstructed?

  • Deficiencies & Corrective Actions

  • Does all emergency and exit lighting work?

  • Deficiencies & Corrective Actions

  • Are all fire extinguishers in place and fully charged?

  • Deficiencies & Corrective Actions

  • Are all eyewash/drench showers in place and in good repair?

  • Deficiencies & Corrective Actions

  • Are all control/electrical panels closed and latched?

  • Deficiencies & Corrective Actions

  • Are employee work stations in good repair and properly setup?

  • Deficiencies & Corrective Actions

  • Housekeeping acceptable?

  • Deficiencies & Corrective Actions

  • Any other unsafe conditions which may pose a hazard to our employees?

  • Deficiencies & Corrective Actions

  • Please list any employee safety concerns, unsafe acts, or ergonomic issues in the spaces below and the corrective action taken in the spaces below.

  • Area Supervisor Name:

  • Area Supervisor Signature:

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