Title Page
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Company/ Facility Name
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Site
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Facility Area
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Conducted on
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Prepared by
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Location
Assessment Part One
Training
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Is training provided for each person newly assigned to a job?
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Does initial training include a thorough review of hazards and accidents associated with the job?
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Is adequate instruction in the use of personal protective equipment provided?
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Is training for the use of emergency equipment provided?
Environment
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Are work surfaces and grip surfaces safe when wet?
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Are elevated work areas properly guarded?
Work Process
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Are repetitive motion tasks properly paced and kept to a minimum?
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Are the material safety data sheets placed in locations accessible to all employees?
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Are hazards signalled by signs and tags?
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Have all trucks, forklifts and other equipment been inspected and maintained?
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Are lockout or tagout procedures in place and followed?
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Is ventilation equipment working effectively?
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Is the dust collection system working correctly?
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Are the safety showers and eye wash stations in the proper locations and in good working condition?
Fire Emergency Procedures
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Is there a clear fire response plan posted for each work area?
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Do all workers know the plan?
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Are drills held regularly?
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Are fire extinguishers chosen for the type of fire most likely in that area?
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Are there enough extinguishers present to do the job?
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Are extinguisher locations conspicuously marked?
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Are extinguishers properly mounted and easily accessible?
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Are all extinguishers fully charged and operable?
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Are extinguisher inspections up to date on all extinguishers?
Means of Exit
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Do employees have easy access to exits?
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Are exits unlocked to allow egress?
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Are exits clearly marked?
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Are exits and exit routes equipped with emergency lighting?
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Are exits and exit routes unblocked and free of clutter?
Warehouse and Shipping
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Are dock platforms, bumpers, stairs and steps in good condition?
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Are light fixtures in good condition?
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Are all work areas clean and free of debris?
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Are stored materials properly stacked and spaced?
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Are floors free of oil spillage or leakage?
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Is absorbent available for immediate clean-up of spills and leaks?
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Are all flammable and combustible products stored appropriately? For example: Are Class I (one) flammable products (as per NFPA or your local fire code) stored in Class I approved buildings or outside the warehouse?
Loading/Unloading Racks
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Are steps, railings and retractable ramps on raised platforms in good repair?
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Is piping and in-line equipment in good condition and free of leaks?
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Are loading arms operating satisfactorily?
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Are bonding and grounding cables free of breaks or damage?
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Are connections tight and sound?
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Is the general condition of wiring and junction boxes, etc. in good condition (visual inspection)?
Lighting
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Is the level of light adequate for safe and comfortable performance of work?
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Is emergency lighting adequate and regularly tested?
Machine Guards
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Are all dangerous machine parts adequately guarded?
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Do machine guards meet standards?
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Are lockout procedures followed when performing maintenance with guards removed?
Electrical
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Are all machines properly grounded?
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Are portable hand tools grounded or double insulated?
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Are junction boxes closed?
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Are extension cords out of the aisles where they can be abused by heavy traffic?
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Is permanent wiring used instead of extension cords?
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Please proceed to the next section.
Assessment Part Two
Tools and Machinery
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Are manufacturers' manuals kept for all tools and machinery?
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Are defective tools/machinery tagged and removed from service as part of a regular maintenance program?
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Are tools and machinery used so as to avoid electrical hazards?
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Is proper training given in the safe use of tools and machinery?
Confined Spaces
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Are the confined space procedures and training available and followed by all involved?
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Are confined spaces properly identified and marked?
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Are entry and exit procedures adequate?
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Are emergency and rescue procedures in place (e.g. trained safety watchers)?
Housekeeping
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Is the work area clean and orderly?
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Are floors free from protruding nails, splinters, holes and loose boards?
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Are aisles and passageways kept clear of obstructions?
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Are permanent aisles and passageways clearly marked?
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Are covers or guardrails in place around open pits, tanks and ditches?
Stairs, Ladders and Platforms
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Are stairs and handrails in good condition?
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Are ladders free of defects?
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Are ladders set up properly before use?
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Are the elevated platforms properly secured and do they have handrails?
Sound Level/Noise
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Are regular noise surveys conducted?
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Is hearing protection available and used properly?
Employee Facilities
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Are facilities kept clean and sanitary?
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Are facilities in good repair?
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Are cafeteria facilities provided away from toxic chemicals?
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Are hand washing facilities available?
Medical and First Aid
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Do all employees know how to get first aid assistance when needed?
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Do the first-aiders know when and to which hospital or clinic an injured person should be taken?
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Are there employees trained as first-aid practitioners on each shift worked?
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Are first-aid kits provided as per jurisdiction’s first-aid regulations?
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Are first-aid supplies replenished as they are used?
Personal Protective Equipment (PPE)
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Is required equipment provided, maintained and used?
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Does equipment meet requirements?
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Is it reliable?
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Is personal protection utilized only when it is not reasonably practicable to eliminate or control the hazardous substance or process?
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Are the areas requiring PPE usage properly identified by warning signs?
Materials Handling and Storage
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Is there safe clearance for all equipment through aisles and doors?
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Is stored material stable and secure?
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Are storage areas free from tipping hazards?
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Are only trained operators allowed to operate forklifts?
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Are necessary warning devices and signs in use for railway sidings?
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Are specifications posted for maximum loads which are approved for shelving, floors and roofs?
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Are racks and platforms loaded only within the limits of their capacity?
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Are chain hoists, ropes and slings adequate for the loads and marked accordingly?
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Do personnel use proper lifting techniques?
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Is the size and condition of containers hazardous to workers?
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Are elevators, hoists, conveyors, balers, etc., properly used with appropriate signals and directional warning signs?
Sign Off
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