Information
General Survey Information
-
Building/Location
-
Date Conducted
-
Prepared by
-
Work Order / Job / Project #
-
Responsible Supervisor
Confined Spaces
-
Is this a confined space?
-
Is permit completed correctly?
-
Was gas monitor calibrated by a qualified individual?
-
Are employees knowledgeable about Confined Space Entry prodecures?
-
Is the OPP Confined Space Program being followed?
Designated Work Space
-
Is the area clearly defined and identified as a work space?
-
Is the area clear of debris and any unnecessary materials?
-
If areas are restricted, are correct procedures being followed to restrict access?
Electrical Safety
-
Are extension cords being used in lieu of permanent equipment?
-
Are extension cords and power strips plugged directly into wall outlets?
-
Are extension cords being run under carpet or through doorways?
-
Are extension cords daisy chained together?
-
Are powerstrips UL rated?
-
Are power cords in good condition and free from splices?
-
Are grounding prongs being removed from extension cords?
-
Are outlet, switch, and junction box covers in place and in good repair?
-
Are circuit breaker panels and emergency shut-offs unobstructed and labeled?
-
Are electrical outlets overloaded with appliances, etc?
-
Are energized part, circuits, and equipment guarded against accidental contact?
-
Are ground fault interruptors installed, labeled, and operating correctly?
Elevated Work Surfaces - Ladders (Non-Fixed)
-
Are ladders in good condition?
-
Do portable ladders have anti-slip feet?
Elevated Work Surfaces - Motorized
-
Are operators licensed in the safe operation of powered industrial trucks and lifts?
-
Has equipment been inspected?
-
Is equipment in good working order?
-
Is personal fall arrest system being used for all aerial lifts?
Elevated Work Surfaces - Scaffolding
-
Is scaffolding in good condition?
-
Has scaffolding been erected properly?
-
Are rails or personal fall arrest system in place?
-
Are pics approved for such use?
-
Has area been properly secured and barricaded around scaffolding?
Floor / Wall openings, Runways, Catwalks (with 4ft or more to next level)
-
Are floor openings properly guarded (railing, toe boards) or covered?
-
Are skylights guarded?
-
Are wall openings (including chutes and chases) properly guarded?
-
Are catwalks equipped with railings and toeboards?
Hazardous Materials
-
Have all hazardous materials been identified?
-
All hazardous materials have been abated or controlled?
Lock Out and Tag Out
-
Is lock out and tag out required?
-
Do employees understand the Lock out and Tag out program and it's requirements?
-
Are proper devices being locked and tagged?
-
Are only the approved lock out and tag out (LOTO) locks being used?
Material Handling and Storage
-
Is there safe clearance for equipment through aisles and doorways?
-
Are containers stored, stacked, secured, and of limited height for stability?
-
Are properly rated dock boards used while loading and unloading trailers?
-
Are trucks and trailers secured from movement during loading and unloading?
-
Are shelving and mezzanines properly rated and marked for loads?
-
Are manual palled jacks, hand-trucks, and dollies in good condition?
-
Are forklifts and motorized pallet jacks inspected each shift or prior to use?
-
Are forklift and motorized pallet jack operators licensed?
-
Are proper lifting techniques being used while lifting or moving loads?
Mechanical Room Safety
-
Are mechanical rooms properly illuminated?
-
Are noise levels within acceptable limits or marked as Hearing Protection Required?
-
Are hearing protective devices readily available in mechanical rooms?
-
Are work areas clean, organized, and kept orderly? (Garbage disposed of properly, etc)
-
Is work area properly ventilated for type of equipment or chemicals in use?
-
Are vacuum systems used when possible instead of blowing or sweeping dusts?
-
Do temperature and humidity seem to be within acceptable ranges?
-
Is the area free of visible fungi/mold growth and associated odors?
-
Are walls, ceilings, floors free of signs of mold or moisture damage?
-
Are air intake areas free of odor-causing materials or hazardous chemicals?
-
Is area free from slip, trip, and fall hazards?
-
Are identified tripping hazards clearly marked?
-
Are low clearance areas clearly marked?
Personal Protective Equipment
-
is appropriate head protection available?
-
Are safety glasses being utilized?
-
Is protective clothing available and used if hazards are present(coveralls, aprons, etc)?
-
Is appropriate hand protection available and used if hazards are present?
-
Is appropriate hearing protection available and used if hazard is present?
-
Is appropriate footwear being utilized?
-
Is respiratory protection required the job?
-
Is PPE being properly stored, kept clean, and in good condition?
Shop Tools
-
Do employees understand safe operation of the power tools they are using?
-
Are tools in good working condition?
-
Are power tools grounded or double insulated?
-
Are rotating or moving parts (chains, gears, belts, etc) properly guarded?
-
Are machine guards secure and do not present a hazard in their use?
-
Is fixed machinery guarded to prevent splash, spark, and flying chip injuries?
-
Is equipment and machinery securely in place and anchored to prevent movement?
-
Are guards and safety interlocks in working condition on the equipment in which it is installed?
-
Is equipment and machinery kept clean and properly maintained?
-
Is there sufficient clearance around machines for safe operation and services?
-
Are power shut-off switches within reach of operators position at each machine?
-
Do machine users understand the safe operation of the machine that they are using?
-
Are manually operated control switches and valves clearly identified and accessible?
-
Are emergency stop buttons available, operable, and colored red?
Trenching and Shoring
-
Are employees following Trenching and Shoring Guidelines?
-
Has "PA One Call" been notified and is the "one call" up to date for the particular dig?
-
Has a "competent" person been identified for this job?
Tunnel Work Areas
-
Are employees following OPP Tunnel Entry Procedures?
-
Are employees following OPP Restricted Entry Guidelines?
Notes/Comments/Actions Required or Taken
-
REMINDER - Use the OPP SAFETY REPORT FORM when hazards cannot be immediately corrected.