Plant Inspection / Audit Form - Final

• Audit Title

• Department / Area Inspected

• Conducted on

  Date
• Plant Location
  Address

• Personnel

• Prepared by

  Sign

Housekeeping 1910.22

• Floor surfaces clean/dry? Free of materials, broken bags, trash, pallets

  Yes

  No

  N/A

• Are all aisles/pathways clear?

  Yes

  No

  N/A

• Equipment Access clear of obstructions such as trash, tools, etc?

  Yes

  No

  N/A

• Work areas/platforms/stairs clean?

  Yes

  No

  N/A

Electrical 1910.303-306

• Floor and Pathways clear of drop cords?

  Yes

  No

  N/A

• Wiring / Temporary extension cords in good shape? (No worn insulation)

  Yes

  No

  N/A

• Temporary wiring / flexible cord properly used? (Good for only 30 days)

  Yes

  No

  N/A

• Junction boxes in good shape?

  Yes

  No

  N/A

• Power panels accessible (3 ft clearance in front) and closed?

  Yes

  No

  N/A

• Conduit or connections are free from exposed wires or damage?

  Yes

  No

  N/A

• All cords have the required ground prong?

  Yes

  No

  N/A

• Are all outlets wired properly? (No loose ground, hot/neutral not reversed)

  Yes

  No

  N/A

Machine Nip-Points 1910.212 & 219

• Are all area guards affixed (ie. On / around palletizer)?

  Yes

  No

  N/A

• Are all flywheels, pulleys, chain / sprockets- including backside guarded?

  Yes

  No

  N/A

• If not - were guards replaced / fabricated immediately?

  Yes

  No

  N/A

• All return idlers (under conveyors) guarded?

  Yes

  No

  N/A

• All conveyor Nip-Points guarded?

  Yes

  No

  N/A

• All rotating shafts guarded (including those with keyway / notch / etc)?

  Yes

  No

  N/A

• All safety devices (E-stops, pull cords) fully operational when testing?

  Yes

  No

  N/A

• Is the bag chair interlock device functioning?

  Yes

  No

  N/A

• All start / stop devices functioning?

  Yes

  No

  N/A

• All other Nip-Points guarded?

  Yes

  No

  N/A

Lockout / Tagout & Confined Space (if observed) 1910.146-147

• Are LO/TO procedures posted as appropriate?

  Yes

  No

  N/A

• Is LO/TO being applied for maintenance activities observed?

  Yes

  No

  N/A

• Is LO/TO or similar applied for minor servicing, ie. Unjamming, cleaning?

  Yes

  No

  N/A

• For group LO/TO (more than one employee in the machine,) is each employee applying their own lock?

  Yes

  No

  N/A

• Do the locks / tags identify the employee(s) involved?

  Yes

  No

  N/A

• For confined space entries observed, are permits completed and safety precautions taken as required?

  Yes

  No

  N/A

Personal Protective Equipment 1910.132-140

• Are employees wearing hearing protection where required?

  Yes

  No

  N/A

• Wearing foot protection where required?

  Yes

  No

  N/A

• Wearing head protection where required?

  Yes

  No

  N/A

• Wearing reflective equipment (ie. vests or tape) as required?

  Yes

  No

  N/A

• Wearing respirators as required in production areas?

  Yes

  No

  N/A

• All employees wearing proper eye protection?

  Yes

  No

  N/A

• Wearing proper hand protection where required?

  Yes

  No

  N/A

• Wearing Fall Equipment (ie. harness) where required?

  Yes

  No

  N/A

• Personal Fall Protection properly used and in good condition (ie. gloves no holes / safety glasses not broken / hard hats properly worn)?

  Yes

  No

  N/A

Stairs / Steps / Ladders / Access to & Work Platforms 1910.21-27

• Stairs / access / rungs safe and secure?

  Yes

  No

  N/A

• Handrails in place where required?

  Yes

  No

  N/A

• Are all hand rails in good shape (secured and stable)?

  Yes

  No

  N/A

• Have all ladders been inspected and in safe usable condition?

  Yes

  No

  N/A

• Are ladders stored correctly?

  Yes

  No

  N/A

• Elevated work platforms secure and safe?

  Yes

  No

  N/A

• All runways / pathways safe and uncluttered?

  Yes

  No

  N/A

• Fall Protection adequate for elevated maintenance activities (if observed)?

  Yes

  No

  N/A

Exits 1910.35, 36, & 37

• Access to exits clear and unobstructed? (No exit doors blocked)

  Yes

  No

  N/A

• Exits adequately marked / lighted?

  Yes

  No

  N/A

• Emergency lights all working properly and tested?

  Yes

  No

  N/A

• Emergency evacuation plan posted?

  Yes

  No

  N/A

Material Storage 1910.101 & 176

• Are aisles (means of egress) free of materials?

  Yes

  No

  N/A

• Is material stacked at an appropriate height?

  Yes

  No

  N/A

• Is stacked material level and stable?

  Yes

  No

  N/A

• Pallets in good / safe condition?

  Yes

  No

  N/A

• Material stored for safe access / retrieval?

  Yes

  No

  N/A

Equipment / Tools / Welding / Cutting 1910.166-171, 1910.241-247

• Tools in safe condition?

  Yes

  No

  N/A

• Tools being used as intended?

  Yes

  No

  N/A

• Hazardous and/or flammable materials stored / used safely?

  Yes

  No

  N/A

• Gas / oxygen cylinders handled and/or stored safely? (Chained and separated)

  Yes

  No

  N/A

• Blowing off properly (not compressed air but with blowers if present)?

  Yes

  No

  N/A

• Hot work permits used for non routine welding (ie. outside the maintenance shop, near flammables, in production near employees, etc)?

  Yes

  No

  N/A

Forklift / FEL Operations 1910.178

• Daily safety checks completed with defects noted (forklifts)?

  Yes

  No

  N/A

• Daily safety checks completed with defects noted (front end loader)?

  Yes

  No

  N/A

• Brakes / handbrakes fully operational and safe?

  Yes

  No

  N/A

• Dock plates / chocks used when needed?

  Yes

  No

  N/A

• Horns fully operational and used?

  Yes

  No

  N/A

• Traveling at safe speeds / safely?

  Yes

  No

  N/A

• Unattended forklifts properly set (brake set, forks lowered, engine off)?

  Yes

  No

  N/A

• Loading of trailers safely / properly?

  Yes

  No

  N/A

• Data plates legible?

  Yes

  No

  N/A

• Mirrors cleaned and adjusted for blind corners?

  Yes

  No

  N/A

• Forklift moving in reverse when loads obstructing the view?

  Yes

  No

  N/A

Manual Material Handling / Lifting 1910.176 & 5 (a)(1)

• Are proper lifting practices being observed?

  Yes

  No

  N/A

• Pallet Pal or similar setup used to hand stack (if observed)?

  Yes

  No

  N/A

• Hoists / Chains / hooks in good condition and inspected regularly?

  Yes

  No

  N/A

Chemicals - Haz Com 1910.1200

• All drums / containers of chemicals properly labeled?

  Yes

  No

  N/A

• Good ventilation where chemicals are used / stored?

  Yes

  No

  N/A

• Are MSDS / SDS sheets available and accessible to employees?

  Yes

  No

  N/A

• Are all eye wash stations working / accessible and within expiration dates?

  Yes

  No

  N/A

Environment

• NO SMOKING policy enforced?

  Yes

  No

  N/A

• Work area comfortable? No signs of heat stress or hypothermia?

  Yes

  No

  N/A

• Usual amount of fugitive dust?

  Yes

  No

  N/A

• Local exhaust ventilation, (duct work) attached and functioning?

  Yes

  No

  N/A

• No standing water on the floor?

  Yes

  No

  N/A

• Is lighting adequate?

  Yes

  No

  N/A

• No noted unusual fumes / vapers in the air?

  Yes

  No

  N/A

• Inspector Name

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• Inspector Name

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• Reviewer Signature

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• Reviewer Signature

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