Title Page
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Site conducted
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Conducted on
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Prepared by
Fall Protection
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Are fall protection devices or fall protection areas going to be inspected?
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Scaffolding not properly adjusted sides to ends of unit to prevent falls (i.e. bridges more than 6" from unit
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Fall protection harness not being worn, or proper fall protection device not in place, while working more than 4 feet above the floor
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Protective chains/gates are not in place at mezzanine/scaffolding loading areas and other access points. All other handrails meet requirements.
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Employees working below an object that could fall/employees operating a hoist or scaffolding without clearing the area
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Scaffolding and hoist controls not functioning properly
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Items set on scaffold or on top of units that are heavy and not secured (i.e. air conditioners, saws, and drills)
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Were repeat violations observed?
Powered Equipment
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Was powered equipment inspected during this audit?
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Powered industrial equipment guard defective
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Powered industrial equipment guard missing or not in use
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Powered industrial equipment left running unattended
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Powered industrial equipment being serviced without being locked out
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Unsafe work practices while operating saw/power equipment
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Power equipment brake failure on saw motor
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Power equipment failure to return to home position
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Saw/machinery not properly secured/anchored
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No push stick evident
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Poor housekeeping at/or around and saw/machinery area
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Failure to use a staple gun in the correct manner
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Staple gun safety defeated
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Are Saw Safety Checklists present
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Are Saw Safety Checklists completed
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Were repeat violations observed?
Material Handling and Storage
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Will material handling and storage elements be inspected in this audit?
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Daily forklift inspections complete
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Pallets/materials/misc. items not being stored safely
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Hopper safety latches not being utilized
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Items stored on racks not secure
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Items stored on racks protruding into aisle/walkway
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Items stored on mezzanines not secure
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Pole stops or other devices used to secure material not in place
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Were repeat violations observed?
Personal Protective Equipment (PPE)
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Will PPE compliance be inspected during this audit?
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Is all other task specific PPE being worn?
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Is hearing protection being used as required?
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Employees/vendors not wearing eye protection when in the plant
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Employees are using more than one ear bud or headphones
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Overall rating of PPE use
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Were repeat violations observed?
Work Practices
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Are improper work practices to be evaluated for this inspection?
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Employees running in the facility
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Employees jumping from unit to floor
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Employees throwing scrap into hoppers more than 6 feet away
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Failure to use utility knives correctly
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Employees carrying items 25 pounds on or over their head
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Non-compliant air blowers being used
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Were repeat violations observed?
Cranes and Hoists
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Were safety elements of cranes and hoists inspected during this audit?
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Hoists being used beyond capacity limits
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Crane pendant damaged
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Crane controller functions illegible
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Crane pendant missing warning tag
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Employees walking/working under a suspended load
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Crane hook safety latch present and functional
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Were repeat violations observed?
Electrical
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Was electrical safety done during this audit?
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Employee use appliances such microwaves and refrigerators plugged directly into an outlet
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Employee use appliances being stored in metal or wooden boxes
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Electrical cabinet doors open
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Electrical cabinet obstructed
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Items being stored in electrical area
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Missing knockout on or inside electrical panel/receptacle
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Damaged electrical cabinet/receptacle
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Extension cords daisy chained together
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Frayed, cut or damaged electrical cords being used
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RPT (power strip) daisy chained to another RPT or extension cord
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Electrical cords being used as permanent wiring
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Improper use or RPT (power strip)
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Electrical cords run through wall holes/doorways
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Exposed battery terminals
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Broken strain relief
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Breaker boxes/transformers in defective condition
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Improper storage in/on electrical equipment
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Were repeat violations observed?
Fire Protection
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Was fire protection inspected during this audit?
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Fire extinguisher obstructed
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Fire extinguisher not properly mounted
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Fire extinguisher sign not present
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Fire extinguisher sign obscured
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Fire extinguisher missing
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Were repeat violations observed?
Exit Routes/Emergency Planning
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Were exit routes and emergency planning components inspected?
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Obstructed exit door, interior/exterior
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Emergency exit light not illuminated
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Emergency exit light damaged
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Were repeat violations observed?
Hazcom/Chemical Storage
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Was Hazcom/chemical storage inspected?
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Improper storage on flammable cabinet
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Improper storage of flammable liquids
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Unmarked/illegible chemical container
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Chemicals and food being stored together
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Flammable cabinet door(s) left open and unattended
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Were repeat violations observed?
Walking/Working Surfaces
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Were walking/working surfaces inspected during this audit
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Housekeeping - General
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Excessive water on floor
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Ladder damaged
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Excessive combustible debris or dust accumulation
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Improper use of a ladder
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Air hoses or cords entering through coach door
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Ladder not secured properly
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Were repeat violations observed?
Compressed Gases
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Was compressed gas storage inspected during this audit?
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LP tank/cylinder not properly secured
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Gas cylinders improperly stored without protective caps
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Were repeat violations observed?
First Aid
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Are first aid supplies readily available?
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Are first aid areas blocked by materials and debris?
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Are AED(s) blocked by materials and debris?
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Are AED(s) available?
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Are eye wash stations readily available?
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Are eye wash stations blocked by materials or debris?
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Were repeat violations observed?
