Peerless Products Supervisor Safety Audit

• Document No.

• Conducted on

  Date

• Audit Conducted by?

• Location audit conducted
  Address

• Personnel present during audit

Housekeeping

• Are all spills, trash and clutter removed?

  Safe

  At Risk

  N/A

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  Media

• Are flammables stored properly?

  Yes

  No

  N/A

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  Media

• Main Aisles/walkways and exits kept clear?

  Safe

  At Risk

  N/A

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  Media

• Work area kept organized?

  Safe

  At Risk

  N/A

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  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?

  Safe

  At Risk

  N/A

• Is ANSI Z87 Eye and face protection worn?

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• Are safety toed shoes being worn?

  Safe

  At Risk

  N/A

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

  Yes

  No

  N/A

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

  Safe

  At Risk

  N/A

• Is all gear worn correctly and in good condition?

  Safe

  At Risk

  N/A

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  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

  Safe

  At Risk

  N/A

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  Media

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

  Safe

  At Risk

  N/A

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  Media

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

  Safe

  At Risk

  N/A

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  Media

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

  Safe

  At Risk

  N/A

• Unprotected or ungaurded work

• Add media

  Media

• Corrective Action

Tools, Equipment, and Machinery

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

• Ladders

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  Media

• Power or hand tools

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  Media

• Machines

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  Media

• Equipment

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  Media

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

  Safe

  At Risk

  N/A

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  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

  Safe

  At Risk

  N/A

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  Media

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

  Safe

  At Risk

  N/A

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  Media

• Safe behaviors are observed

  Safe

  At Risk

  N/A

• Encouragement Steps

• Corrective Actions for issues identified within procedures and behaviors

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