Partners

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Stairs, Floors, Floor Opening, Wall and Hoistway Openings

• Are stair trends secure and in good condition?

  Yes

  No

  N/A

• Are hand railings adequate and in good condition?

  Yes

  No

  N/A

• Is stairwell lighting adequate?

  Yes

  No

  N/A

• Are floor surfaces free of our protruding nails, splinters, holes, loose boards, and other slip, trip and fall hazards?

  Yes

  No

  N/A

• Are floor openings properly guarded?

  Yes

  No

  N/A

• Is floor loading within proper limits?

  Yes

  No

  N/A

Elevated Runways and Platforms

• Are they clear from obstructions and provided with handrails and toeboards?

  Yes

  No

  N/A

• Is safe means of access and exit provided by employees?

  Yes

  No

  N/A

Elevators and Other Equipment

• Are shaftway gates and doors in good order? Are they properly used?

  Yes

  No

  N/A

• Is shaftway door hazard protection provided?

  Yes

  No

  N/A

• Do qualified persons operate equipment?

  Yes

  No

  N/A

• Is it possible to open shaftway doors when car or platform is not at that level?

  Yes

  No

  N/A

• Are safety interlocks properly working?

  Yes

  No

  N/A

• Is lighting adequate?

  Yes

  No

  N/A

Machine and Transmission Hazards

• Are all guards in place and properly used?

  Yes

  No

  N/A

• Are all power transmission, moving machine parts and points of operations guarded?

  Yes

  No

  N/A

• Are all pinch points properly guarded?

  Yes

  No

  N/A

• Are there adjustable hoods and safety flanges on abrasive wheels?

  Yes

  No

  N/A

• Is exhaust equipment operating efficiently?

  Yes

  No

  N/A

• Are dust collectors cleaned frequently?

  Yes

  No

  N/A

• Are switches conveniently located so power will be shut off for oiling, repair, or maintenance?

  Yes

  No

  N/A

• Is a Lockout/Tagout program in place?

  Yes

  No

  N/A

• Is Lockout/Tagout equipment available to all shifts?

  Yes

  No

  N/A

Electrical Equipment

• Are switchboards, transformers, control and operating apparatus in good condition?

  Yes

  No

  N/A

• Are they properly protected or isolated?

  Yes

  No

  N/A

• Are electrical floor mats placed at switchboards and circuit breakers boxes?

  Yes

  No

  N/A

• Are empty breaker slots covered with proper blank panel inserts?

  Yes

  No

  N/A

Pressure Apparatus

• Are safety and relief valves in good working order?

  Yes

  No

  N/A

• Has pressure apparatus been inspected as required?

  Yes

  No

  N/A

Fire Hazards

• Are flammable materials properly handled and safely stored?

  Yes

  No

  N/A

• Is workplace free of excess flammable waste and rubbish?

  Yes

  No

  N/A

• Is flammable waste and rubbish kept in approved containers until removed from the premises?

  Yes

  No

  N/A

• Are fire extinguishers appropriate for the type of fire?

  Yes

  No

  N/A

• Are fire extinguishers regularly inspected and tagged?

  Yes

  No

  N/A

• Do employees know location of nearest fire exit and an alternative exit?

  Yes

  No

  N/A

• Are emergency exits plainly marked and unobstructed?

  Yes

  No

  N/A

Power Traveling (Bridge) Cranes

• Are footwalks, railings, ladders and safety applications in good condition?

  Yes

  No

  N/A

• Is limit of capacity posted and enforced?

  Yes

  No

  N/A

• Are cables, chains, hooks and wire slings inspected?

  Yes

  No

  N/A

• Are warning signals used and understood?

  Yes

  No

  N/A

General Conditions

• Are medical facilities satisfactory?

  Yes

  No

  N/A

• Are there sufficient first aid kits and supplies?

  Yes

  No

  N/A

• Is appropriate personal protective equipment (PPE) available?

  Yes

  No

  N/A

• Is PPE used by employees?

  Yes

  No

  N/A

• Are passageways and aisles adequately wide and well defined?

  Yes

  No

  N/A

• Are all ladders in safe condition and inspected regularly?

  Yes

  No

  N/A

• Are all chemicals labeled, handled and stored safely?

  Yes

  No

  N/A

• Are portable power and hand tools maintained in safe condition?

  Yes

  No

  N/A

• Is there adequate light throughout the workplace?

  Yes

  No

  N/A

• Is material piled or stored in a safe manner?

  Yes

  No

  N/A

• Are hand and power trucks stored safely?

  Yes

  No

  N/A

• Is transportation equipment in good condition?

  Yes

  No

  N/A

• Are outside grounds safe - yards/ parking lots/ roadways?

  Yes

  No

  N/A

Wrap Up

• List other unsafe conditions or unsafe acts observed.

  Safe

  At Risk

  N/A

• List safety suggestions.

  Safe

  At Risk

  N/A

• Record names of safety survey team/safety committee members

  Yes

  No

  N/A