Physical Inspection Form #2

• Report Title

• Site

• Conducted on

  Date

• Prepared by

• Other personnel involved

Section 1: Machinery, equipment and guarding

• Must be clean and free of unnecessary material and hangings

  Yes

  No

  N/A

• Must be free of unnecessary dripping of oil or grease

  Yes

  No

  N/A

• Must have proper guards provided and in good condition

  Yes

  No

  N/A

Section 2: Stock and material

• Must be properly piled and stored

  Yes

  No

  N/A

• Chemicals must be properly labelled

  Yes

  No

  N/A

Section 3: Tools and PPE

• Must be properly stored

  Yes

  No

  N/A

• Must be free of oil and grease when stored

  Yes

  No

  N/A

• Must be in safe working condition

  Yes

  No

  N/A

Section 4: Aisles

• Must be provided to work positions, fire extinguishers, fire blankets & stretcher cases

  Yes

  No

  N/A

• Must be safe and free of obstructions

  Yes

  No

  N/A

• Must be clearly marked

  Yes

  No

  N/A

Section 5: Floors

• Must have surfaces safe and suitable to work

  Yes

  No

  N/A

• Must be clean, dry and free of refuse, unnecessary material, oil and grease

  Yes

  No

  N/A

• Must have adequate number of receptacles provided for refuse

  Yes

  No

  N/A

Section 6: Buildings and grounds

• Must have walls and windows that are reasonably clean for operations in that area and free of unnecessary hangings

  Yes

  No

  N/A

• Must have lighting systems that are maintained in a clean and efficient manner

  Yes

  No

  N/A

• Must have stairs/platforms that are clean, free of materials well lit, with adequate handrails & treads in good condition

  Yes

  No

  N/A

• Must be in good order

  Yes

  No

  N/A

Section 7: Electrical

• Must be in good order with proper controls and systems

  Yes

  No

  N/A

Section 8: Substandard Physical Conditions

• ITEM 1

• Describe the substandard condition found and what will happen to correct it

• Take a photo of the substandard condition

  Media

• What is the hazard classification?

  A - Critical

  B - Serious

  C - Minor

• Note: An incident report or HIRA must be raised for any A or B hazards

• A - Rectified immediately, B - Rectified within 1 wk, C - Rectified within appropriate timeframe

• Has the substandard condition been fixed?

  Yes

  No

  N/A

• If 'No' then record action required, person assigned to action and due date

• ITEM 2

• Describe the substandard condition found and what will happen to correct it

• Take a photo of the substandard condition

  Media

• What is the hazard classification?

  A - Critical

  B - Serious

  C - Minor

• Has the substandard condition been fixed?

  Yes

  No

  N/A

Section 9: Closing the Report

• The report can be closed when all items have been fixed or action plans have been determined

• DC Manager to confirm report closure

  Sign

• Date report was closed

  Date