• Are all spills, trash and clutter removed?

  • Add media

  • Are flammables stored properly?

  • Add media

  • Main Aisles/walkways and exits kept clear?

  • Add media

  • Work area kept organized?

  • Add media

  • Corrective Actions for Housekeeping issues identified

Personal Protective Equipment

  • Identify required PPE for department or task, indicate SAFE if worn, N/A if not applicable to your department

  • Head Protection worn?

  • Is ANSI Z87 Eye and face protection worn?

  • Are proper gloves being worn for the task at hand?

  • Is respiratory protection being worn where there is an existing inhalation hazard?

  • Are safety toed shoes being worn?

  • Where there are bodily hazards that exists is proper equipment being worn? (sleeves, chemical resistant jackets or kevlar)

  • Is fall protection worn in areas over 4 feet high?

  • Is all gear worn correctly and in good condition?

  • Add media

  • Corrective Actions for PPE issues identified

Working Position

  • Identify if working postures are safe with SAFE, AT RISK, if not Applicable put N/A.

  • Working posture is safe not over stretched

  • Add media

  • Is there no above shoulder lifting, below the knees lifting or twisting?

  • Add media

  • Is employee positioned in work environment to reduce the likelihood of struck by or caught in between hazards?

  • Add media

  • Is there any work being conducted at height above 4 feet?

  • Unprotected or ungaurded work

  • Add media

  • Corrective Action

Tools, Equipment, and Machinery

  • Check the box if the following is identified to be IN POOR CONDITION OR UNSAFE:

  • Ladders

  • Add media

  • Power or hand tools

  • Add media

  • Machines

  • Add media

  • Equipment

  • Add media

  • Appropriate tools, or machinery and equipment being used for the task?

  • Add media

  • Corrective Actions for issues identified within tools, equipment and machinery

Safe Procedures and Safe Behaviors

  • Powered industrial equipment procedures are followed: including powered pallet jacks, fork lifts, cranes hoists and vacuum lifts

  • Add media

  • Departmental specific safety procedures are followed: material handling and staging, Lockout/Tagout, hot work permit

  • Add media

  • Safe behaviors are observed

  • Encouragement Steps

  • Corrective Actions for issues identified within procedures and behaviors

  • Add signature

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