PVNA Safety Template

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Which department are you inspecting?

  Select Molding Warehouse Maintenance QC Cut Sleeve BOV Component Assembly/Extrusion Technical Service Lab Die Shop Tool Room Final Valve and Stem Stamping

  • Molding
  • Warehouse
  • Maintenance QC
  • Cut Sleeve BOV
  • Component Assembly/Extrusion
  • Technical Service Lab
  • Die Shop
  • Tool Room
  • Final Valve and Stem
  • Stamping

Housekeeping

• Walkways maintained, aisle defined, uncluttered

  Yes

  No

  N/A

• Is storage maintained within the markings on the floor

  Yes

  No

  N/A

• Are floors adequately swept, mopped, vacuumed and free of slipping/tripping/fall hazards

  Yes

  No

  N/A

• Emergency exits clearly identified/unobstructed

  Yes

  No

  N/A

• Emergency evacuation route clearly defined and displayed

  Yes

  No

  N/A

• Unapproved doors clearly marked “NOT AN EXIT”

  Yes

  No

  N/A

• Stairs free from material storage and debris

  Yes

  No

  N/A

• All trash removed and trash cans in place

  Yes

  No

  N/A

• Is the work and storage areas clean and orderly

  Yes

  No

  N/A

• First aid responders available for each shift

  Yes

  No

  N/A

Signs and Postings

• Safety Policy is posted and up to date

  Yes

  No

  N/A

• Emergency evacuation plan is posted and up to date

  Yes

  No

  N/A

• Safety Alert's are posted including other sites

  Yes

  No

  N/A

• Safety Pyramid is up to date

  Yes

  No

  N/A

• Unsafe and Near miss report forms are readily available to all employees

  Yes

  No

  N/A

Emergency Medical

• Emergency contact information posted

  Yes

  No

  N/A

• First Aid supplies adequate and available

  Yes

  No

  N/A

• Bloodborne pathogens exposure kits available

  Yes

  No

  N/A

• Transportation available for injured worker plan in place

  Yes

  No

  N/A

Slip/Trip Fall Hazards

• Stairways in good condition with handrails, treads, and risers in proper proportion and non-slip

  Yes

  No

  N/A

• Portable ladders equipped with non-slip feet. Metal ladders marked "DO NOT USE AROUND ELECTRICAL EQUIPMENT"

  Yes

  No

  N/A

• Work areas, aisle ways, and storage areas are orderly

  Yes

  No

  N/A

• Elevated areas have guardrails and toe boards

  Yes

  No

  N/A

• Illumination adequate for normal conditions, emergency lighting in place

  Yes

  No

  N/A

• External walking, parking, and break areas free of potential hazard

  Yes

  No

  N/A

• Warning signs posted for wet floors and spills

  Yes

  No

  N/A

• Antislip mats and flooring used where appropriate

  Yes

  No

  N/A

Hand Tools

• Power tools properly grounded/have safety power switch

  Yes

  No

  N/A

• Defective tools are removed from service

  Yes

  No

  N/A

• Proper guards are provided, tools electrically grounded or double insulated

  Yes

  No

  N/A

• There is a preventative maintenance/inspection program

  Yes

  No

  N/A

Fire Safety

• Portable fire extinguishers are mounted properly, accessible, and inspected /access unobstructed

  Yes

  No

  N/A

• Approved safety containers are used for flammable liquids & clearly marked

  Yes

  No

  N/A

• Bonding and grounding used with storage of flammable materials

  Yes

  No

  N/A

• Combustible debris disposed of regularly

  Yes

  No

  N/A

• “No Smoking” area designated

  Yes

  No

  N/A

• Sprinkler system functional, inspected, and documented

  Yes

  No

  N/A

• Smoke/heat detectors functional and inspected

  Yes

  No

  N/A

• Minimum 18” clearance below sprinkler heads

  Yes

  No

  N/A

• Sprinkler valves locked open

  Yes

  No

  N/A

Electrical Hazards

• Machinery and equipment are grounded per code

  Yes

  No

  N/A

• Electrical panels have clear access

  Yes

  No

  N/A

• Electrical panels are clearly marked

  Yes

  No

  N/A

• Are all breaker boxes, junction boxes, electrical panels securely closed

  Yes

  No

  N/A

• Outlet, switches, and boxes have covers and labels

  Yes

  No

  N/A

• Permanent wiring in place – no extension cords

  Yes

  No

  N/A

• Exposure of overhead electrical lines controlled

  Yes

  No

  N/A

• Emergency stops and critical electrical controls are identified

  Yes

  No

  N/A

• Appropriate electrical systems designed for hazardous location have been installed in spray booths and flammable liquid storage rooms

  Yes

  No

  N/A

Material Handling Equipment

• Materials are neatly and safely stored

  Yes

  No

  N/A

• Containers used for storage are in good condition

  Yes

  No

  N/A

• Storage areas free from tripping hazards

  Yes

  No

  N/A

• Pallets and skids are inspected before use

  Yes

  No

  N/A

• Weight limits are clearly marked on shelving

  Yes

  No

  N/A

• Boxes over allowed lifting weight are marked

  Yes

  No

  N/A

• Shelving and platforms are in good condition

  Yes

  No

  N/A

Forklift Operations

• Observed operating at safe speeds

  Yes

  No

  N/A

• Observed safe loading and unloading practices

  Yes

  No

  N/A

• Equipped with back up alarms

  Yes

  No

  N/A

• Operators qualified and trained

  Yes

  No

  N/A

• Equipment inspected beginning of each shift

  Yes

  No

  N/A

• Seat belts worn properly

  Yes

  No

  N/A

• Mirrors installed at blind spots

  Yes

  No

  N/A

• Horns Operational

  Yes

  No

  N/A

Mechanical and Manual Handling and Storage

• Hoist chains, cables, and slings are inspected regularly and documented

  Yes

  No

  N/A

• Load limits are posted for all floors above ground level

  Yes

  No

  N/A

• Load limits are displayed on all hoists

  Yes

  No

  N/A

• Manual handling aids available and used

  Yes

  No

  N/A

• Weight limits are set for manual lifting, carrying, pushing, and pulling

  Yes

  No

  N/A

• Workers trained in proper lifting techniques and ergonomics

  Yes

  No

  N/A

Procedures

• There is a procedure for each task

  Yes

  No

  N/A

• Procedure includes safety requirements and personal protective equipment requirements

  Yes

  No

  N/A

Training (Verification of any training will be based on review of the training rosters)

• Personnel are trained in the task they are doing

  Yes

  No

  N/A

• There is a training matrix for each department with required training for each task

  Yes

  No

  N/A

• Employees are up to date in required training (task and safety )

  Yes

  No

  N/A

• Safety talks are being performed on a weekly basis

  Yes

  No

  N/A

• Safety alerts from all sites are reviewed

  Yes

  No

  N/A

• Initial training includes a thorough review of hazards and incidents associated with the task

  Yes

  No

  N/A

Risk Assessments

• Risk assessments have been completed for each task in the department

  Yes

  No

  N/A

• The risk assessment has been reviewed by the employees doing the task

  Yes

  No

  N/A

Machinery

• Lockout/tagout program in place, locks available, and employees trained

  Yes

  No

  N/A

• Hazardous areas painted bright colors

  Yes

  No

  N/A

• Guards are provided for “point of operation” of machinery

  Yes

  No

  N/A

• Clothing and hair restrictions are in place to prevent entanglement in machinery

  Yes

  No

  N/A

• Power transmission guards are in place

  Yes

  No

  N/A

• Noise exposures measured and documented

  Yes

  No

  N/A

• Warning labels displayed in obvious locations

  Yes

  No

  N/A

• Compressed air hoses have proper nozzles on them

  Yes

  No

  N/A

• Air hoses provided with safety latch to prevent accidental disconnect

  Yes

  No

  N/A

• Overhead hazards from equipment, conveyors, and process pipes are guarded below 7 feet from the door

  Yes

  No

  N/A

Chemicals

• Hazardous materials containers are properly labeled

  Yes

  No

  N/A

• Safety Data Sheets Available

  Yes

  No

  N/A

• Hazard Communication Training program in place

  Yes

  No

  N/A

• Smoking and eating prohibited in work areas where chemicals are used

  Yes

  No

  N/A

• Eye wash and emergency shower available, functional, inspected and documented

  Yes

  No

  N/A

Personal Protective Equipment

• Employees trained in the use and maintenance of PPE – training documented

  Yes

  No

  N/A

• PPE assessment performed and requirements in place

  Yes

  No

  N/A

• Hearing protecting utilized in required areas

  Yes

  No

  N/A

• Face and eye protection in place where needed

  Yes

  No

  N/A

• Safety shoe protection in place where needed

  Yes

  No

  N/A

• Protective clothing, gloves, aprons, boots, face shields, and goggles are used when handling hazardous materials

  Yes

  No

  N/A

Environmental Management System

• There is no evidence of broken lamps

  Yes

  No

  N/A

• Used rags, gloves, mats are kept in covered containers

  Yes

  No

  N/A

• There are no used batteries in the trash

  Yes

  No

  N/A

• Used batteries are recycled in the proper collection container

  Yes

  No

  N/A

• Waste oil, emulsion, spent light bulbs, etc are all dated with start accumulation date

  Yes

  No

  N/A

• All leaks and spills are properly contained

  Yes

  No

  N/A

Finish

• Notify manager of completion.

  Ok

  Not finished

Housekeeping

• Walkways maintained, aisle defined, uncluttered

  Yes

  No

  N/A

• Is storage maintained within the markings on the floor

  Yes

  No

  N/A

• Are floors adequately swept, mopped, and free of slipping/tripping/fall hazards

  Yes

  No

  N/A

• Emergency exits clearly identified/unobstructed

  Yes

  No

  N/A

• Emergency evacuation route clearly defined and displayed

  Yes

  No

  N/A

• Unapproved doors clearly marked “NOT AN EXIT”

  Yes

  No

  N/A

• All trash removed

  Yes

  No

  N/A

• Is the work and storage areas clean and orderly

  Yes

  No

  N/A

• First aid responders available for each shift

  Yes

  No

  N/A

Signs and Postings

• Safety Policy is posted and up to date

  Yes

  No

  N/A

• Emergency evacuation plan is posted and up to date

  Yes

  No

  N/A

• Safety Alert's are posted including other sites

  Yes

  No

  N/A

• Safety Pyramid is up to date

  Yes

  No

  N/A

• Unsafe and Near miss report forms are readily available to all employees

  Yes

  No

  N/A

Emergency Medical

• Emergency contact information posted

  Yes

  No

  N/A

• First Aid supplies adequate and available

  Yes

  No

  N/A

• Bloodborne pathogens exposure kits available

  Yes

  No

  N/A

Slip/Trip/Fall Hazards

• Stairways in good condition with handrails, treads, and risers in proper proportion and non-slip

  Yes

  No

  N/A

• Portable ladders equipped with non-slip feet. Metal ladders marked "DO NOT USE AROUND ELECTRICAL EQUIPMENT"

  Yes

  No

  N/A

• Work areas, aisle ways, and storage areas are orderly

  Yes

  No

  N/A

• Elevated areas have guardrails and toe boards

  Yes

  No

  N/A

• Illumination adequate for normal conditions, emergency lighting in place

  Yes

  No

  N/A

• External walking, parking, and break areas free of potential hazard

  Yes

  No

  N/A

• Warning signs posted for wet floors and spills

  Yes

  No

  N/A

Hand Tools

• Defective tools are removed from service

  Yes

  No

  N/A

• Are box cutters handled in a safe manner, stored with blade closed

  Yes

  No

  N/A

Fire Safety

• Portable fire extinguishers are mounted properly, accessible, and inspected /access unobstructed

  Yes

  No

  N/A

• Approved safety containers are used for flammable liquids & clearly marked

  Yes

  No

  N/A

• “No Smoking” area designated

  Yes

  No

  N/A

• Sprinkler system functional, inspected, and documented

  Yes

  No

  N/A

• Smoke/heat detectors functional and inspected

  Yes

  No

  N/A

• Minimum 18” clearance below sprinkler heads

  Yes

  No

  N/A

• Sprinkler valves locked open

  Yes

  No

  N/A

Electrical Hazards

• Machinery and equipment are grounded per code

  Yes

  No

  N/A

• Electrical panels have clear access

  Yes

  No

  N/A

• Electrical panels are clearly marked

  Yes

  No

  N/A

• Are all breaker boxes, junction boxes, electrical panels securely closed

  Yes

  No

  N/A

• Outlet, switches, and boxes have covers and labels

  Yes

  No

  N/A

• Permanent wiring in place – no extension cords

  Yes

  No

  N/A

• Exposure of overhead electrical lines controlled

  Yes

  No

  N/A

• Emergency stops and critical electrical controls are identified

  Yes

  No

  N/A

Material Handling Equipment

• Materials are neatly and safely stored

  Yes

  No

  N/A

• Containers used for storage are in good condition

  Yes

  No

  N/A

• Storage areas free from tripping hazards

  Yes

  No

  N/A

• Pallets and skids are inspected before use

  Yes

  No

  N/A

• Weight limits are clearly marked on shelving

  Yes

  No

  N/A

• Shelving and platforms are in good condition

  Yes

  No

  N/A

Forklift Operations

• Observed operating at safe speeds

  Yes

  No

  N/A

• Observed safe loading and unloading practices

  Yes

  No

  N/A

• Equipped with back up alarms

  Yes

  No

  N/A

• Operators qualified and trained

  Yes

  No

  N/A

• Equipment inspected beginning of each shift

  Yes

  No

  N/A

• Seat belts worn properly

  Yes

  No

  N/A

• Mirrors installed at blind spots

  Yes

  No

  N/A

• Horns Operational

  Yes

  No

  N/A

Company Vehicle

• If Observed, was the vehicle operating at a safe speed

  Yes

  No

  N/A

• Vehicle inspections are done per shift/driver/vehicle

  Yes

  No

  N/A

• Vehicle is kept up with (clean and free of damage)

  Yes

  No

  N/A

Mechanical and Manual Handling and Storage

• Load limits are posted for all floors above ground level

  Yes

  No

  N/A

• Load limits are displayed on all hoists

  Yes

  No

  N/A

• Manual handling aids available and used

  Yes

  No

  N/A

• Weight limits are set for manual lifting, carrying, pushing, and pulling

  Yes

  No

  N/A

• Workers trained in proper lifting techniques and ergonomics

  Yes

  No

  N/A

Procedures

• There is a procedure for each task

  Yes

  No

  N/A

• Procedure includes safety requirements and personal protective equipment requirements

  Yes

  No

  N/A

Training (Verification of any training will be based on review of the training rosters)

• Personnel are trained in the task they are doing

  Yes

  No

  N/A

• There is a training matrix for each department with required training for each task

  Yes

  No

  N/A

• Employees are up to date in required training (task and safety )

  Yes

  No

  N/A

• Safety talks are being performed on a weekly basis

  Yes

  No

  N/A

• Safety alerts from all sites are reviewed

  Yes

  No

  N/A

• Initial training includes a thorough review of hazards and incidents associated with the task

  Yes

  No

  N/A

Risk Assessments

• Risk assessments have been completed for each task in the department

  Yes

  No

  N/A

• The risk assessment has been reviewed by the employees doing the task

  Yes

  No

  N/A

Machinery

• Lockout/tagout program in place, locks available, and employees trained

  Yes

  No

  N/A

• Noise exposures measured and documented

  Yes

  No

  N/A

• Warning labels displayed in obvious locations

  Yes

  No

  N/A

Chemicals

• Hazardous materials containers are properly labeled

  Yes

  No

  N/A

• Safety Data Sheets Available

  Yes

  No

  N/A

• Hazard Communication Training program in place

  Yes

  No

  N/A

• Smoking and eating prohibited in work areas where chemicals are used

  Yes

  No

  N/A

• Eye wash and emergency shower available, functional, inspected and documented

  Yes

  No

  N/A

Personal Protective Equipment

• Employees trained in the use and maintenance of PPE – training documented

  Yes

  No

  N/A

• PPE assessment performed and requirements in place

  Yes

  No

  N/A

• Hearing protecting utilized in required areas

  Yes

  No

  N/A

• Face and eye protection in place where needed

  Yes

  No

  N/A

• Safety shoe protection in place where needed

  Yes

  No

  N/A

• Protective clothing, gloves, aprons, boots, face shields, and goggles are used when handling hazardous materials

  Yes

  No

  N/A

Environmental Management System

• There is no evidence of broken lamps

  Yes

  No

  N/A

• Used rags, gloves, mats are kept in covered containers

  Yes

  No

  N/A

• There are no used batteries in the trash

  Yes

  No

  N/A

• Used batteries are recycled in the proper collection container

  Yes

  No

  N/A

• Waste oil, emulsion, spent light bulbs, etc are all dated with start accumulation date

  Yes

  No

  N/A

• All leaks and spills are properly contained

  Yes

  No

  N/A

Finish

• Notify manager of completion.

  Ok

  Not finished

Housekeeping

• Walkways maintained, aisle defined, uncluttered

  Yes

  No

  N/A

• Is storage maintained within the markings on the floor, racks and tables

  Yes

  No

  N/A

• Are floors adequately swept, mopped, vacuumed and free of slipping/tripping/fall hazards

  Yes

  No

  N/A

• Emergency exits clearly identified/unobstructed

  Yes

  No

  N/A

• Unapproved doors clearly marked “NOT AN EXIT”

  Yes

  No

  N/A

• Stairs free from material storage and debris

  Yes

  No

  N/A

• All trash removed

  Yes

  No

  N/A

• Is the work and storage areas clean and orderly

  Yes

  No

  N/A

• First aid responders available for each shift

  Yes

  No

  N/A

• Are cabinet tops toolboxes and tables clean and not used for storage

  Yes

  No

  N/A

Signs and Postings

• Safety Policy is posted and up to date

  Yes

  No

  N/A

• Emergency evacuation plan is clearly defined, posted and up to date

  Yes

  No

  N/A

• Safety Alert's are posted including other sites

  Yes

  No

  N/A

• Safety Pyramid is up to date

  Yes

  No

  N/A

• Unsafe and Near miss report forms are readily available to all employees

  Yes

  No

  N/A

Emergency Medical

• Bloodborne pathogens exposure kits available

  Yes

  No

  N/A

• First Aid supplies adequate and available

  Yes

  No

  N/A

• Emergency contact information posted

  Yes

  No

  N/A

Slip/Trip/Fall Hazards

• Stairways in good condition with handrails, treads, and risers in proper proportion and non-slip

  Yes

  No

  N/A

• Portable ladders equipped with non-slip feet. Metal ladders marked "DO NOT USE AROUND ELECTRICAL EQUIPMENT"

  Yes

  No

  N/A

• Work areas, aisle ways, and storage areas are orderly

  Yes

  No

  N/A

• Elevated areas have guardrails and toe boards

  Yes

  No

  N/A

• Illumination adequate for normal conditions, emergency lighting in place

  Yes

  No

  N/A

• External walking, parking, and break areas free of potential hazard

  Yes

  No

  N/A

• Warning signs posted for wet floors and spills

  Yes

  No

  N/A

• Antislip mats and flooring used where appropriate

  Yes

  No

  N/A

Hand Tools

• Power tools properly grounded/have safety power switch

  Yes

  No

  N/A

• Defective tools are removed from service

  Yes

  No

  N/A

• Proper guards are provided, tools electrically grounded or double insulated

  Yes

  No

  N/A

• Grinders/Sanders bridge gaps set max 1/8"

  Yes

  No

  N/A

• There is a preventative maintenance/inspection program

  Yes

  No

  N/A

Fire Safety

• Portable fire extinguishers are mounted properly, accessible, and inspected /access unobstructed

  Yes

  No

  N/A

• Approved safety containers are used for flammable liquids & clearly marked

  Yes

  No

  N/A

• Bonding and grounding used with storage of flammable materials

  Yes

  No

  N/A

• Combustible debris disposed of regularly

  Yes

  No

  N/A

• “No Smoking” area designated

  Yes

  No

  N/A

• Sprinkler system functional, inspected, and documented

  Yes

  No

  N/A

• Smoke/heat detectors functional and inspected

  Yes

  No

  N/A

• Minimum 18” clearance below sprinkler heads

  Yes

  No

  N/A

• Sprinkler valves locked open

  Yes

  No

  N/A

Electrical Hazards

• Machinery and equipment are grounded per code

  Yes

  No

  N/A

• Electrical panels have clear access

  Yes

  No

  N/A

• Electrical panels are clearly marked

  Yes

  No

  N/A

• Are all breaker boxes, junction boxes, electrical panels securely closed

  Yes

  No

  N/A

• Outlet, switches, and boxes have covers and labels

  Yes

  No

  N/A

• Permanent wiring in place – no extension cords

  Yes

  No

  N/A

• Exposure of overhead electrical lines controlled

  Yes

  No

  N/A

• Emergency stops and critical electrical controls are identified

  Yes

  No

  N/A

• Appropriate electrical systems designed for hazardous location have been installed in spray booths and flammable liquid storage rooms

  Yes

  No

  N/A

Material Handling Equipment

• Materials are neatly and safely stored on metal racks and in supply cage

  Yes

  No

  N/A

• Containers used for storage are in good condition

  Yes

  No

  N/A

• Storage areas free from tripping hazards

  Yes

  No

  N/A

• Pallets and skids are inspected before use

  Yes

  No

  N/A

• Weight limits are clearly marked on shelving

  Yes

  No

  N/A

• Boxes over allowed lifting weight are marked

  Yes

  No

  N/A

• Shelving and platforms are in good condition

  Yes

  No

  N/A

Forklift Operations

• Observed operating at safe speeds

  Yes

  No

  N/A

• Observed safe loading and unloading practices

  Yes

  No

  N/A

• Equipped with back up alarms

  Yes

  No

  N/A

• Operators qualified and trained

  Yes

  No

  N/A

• Equipment inspected beginning of each shift

  Yes

  No

  N/A

• Seat belts worn properly

  Yes

  No

  N/A

• Mirrors installed at blind spots

  Yes

  No

  N/A

• Horns Operational

  Yes

  No

  N/A

Company Vehicle

• If Observed, was the vehicle operating at a safe speed

  Yes

  No

  N/A

• Vehicle inspections are done per shift/driver/vehicle

  Yes

  No

  N/A

• Vehicle is kept up with (clean and free of damage)

  Yes

  No

  N/A

Mechanical and Manual Handling and Storage

• Hoist chains, cables, and slings are inspected regularly and documented

  Yes

  No

  N/A

• Load limits are posted for all floors above ground level

  Yes

  No

  N/A

• Load limits are displayed on all hoists

  Yes

  No

  N/A

• Manual handling aids available and used

  Yes

  No

  N/A

• Weight limits are set for manual lifting, carrying, pushing, and pulling

  Yes

  No

  N/A

• Workers trained in proper lifting techniques and ergonomics

  Yes

  No

  N/A

Risk Assessments

• Risk assessments have been completed for each task in the department

  Yes

  No

  N/A

• The risk assessment has been reviewed by the employees doing the task

  Yes

  No

  N/A

Machinery

• Lockout/tagout program in place, locks available, and employees trained

  Yes

  No

  N/A

• Hazardous areas painted bright colors

  Yes

  No

  N/A

• Guards are provided for “point of operation” of machinery

  Yes

  No

  N/A

• Clothing and hair restrictions are in place to prevent entanglement in machinery

  Yes

  No

  N/A

• Power transmission guards are in place

  Yes

  No

  N/A

• Noise exposures measured and documented

  Yes

  No

  N/A

• Warning labels displayed in obvious locations

  Yes

  No

  N/A

• Compressed air hoses have proper nozzles on them

  Yes

  No

  N/A

• Air hoses provided with safety latch to prevent accidental disconnect

  Yes

  No

  N/A

• Welding equipment in good condition

  Yes

  No

  N/A

• Compressed gas cylinders are secured to prevent falling

  Yes

  No

  N/A

• Overhead hazards from equipment, conveyors, and process pipes are guarded below 7 feet from the door

  Yes

  No

  N/A

• Compressed gas cylinders are properly labeled to include if it is empty

  Yes

  No

  N/A

Chemicals

• Hazardous materials containers are properly labeled

  Yes

  No

  N/A

• Safety Data Sheets Available

  Yes

  No

  N/A

• Hazard Communication Training program in place

  Yes

  No

  N/A

• Smoking and eating prohibited in work areas

  Yes

  No

  N/A

• Eye wash and emergency shower available, functional, inspected and documented

  Yes

  No

  N/A

Personal Protective Equipment

• Employees trained in the use and maintenance of PPE – training documented

  Yes

  No

  N/A

• PPE assessment performed and requirements in place

  Yes

  No

  N/A

• Hearing protecting utilized in required areas

  Yes

  No

  N/A

• Face and eye protection in place where needed

  Yes

  No

  N/A

• Safety shoe protection in place where needed

  Yes

  No

  N/A

• Protective clothing, gloves, aprons, boots, face shields, and goggles are used when handling hazardous materials

  Yes

  No

  N/A

Environmental Management System

• There is no evidence of broken lamps

  Yes

  No

  N/A

• Used rags, gloves, mats are kept in covered containers

  Yes

  No

  N/A

• Used batteries are recycled in the proper collection container

  Yes

  No

  N/A

• Waste oil, emulsion, spent light bulbs, etc are all dated with start accumulation date

  Yes

  No

  N/A

• All leaks and spills are properly contained

  Yes

  No

  N/A

Finish

• Notify manager of completion.

  Ok

  Not finished

Housekeeping

• Walkways maintained, aisle defined, uncluttered

  Yes

  No

  N/A

• Is storage maintained within the markings on the floor

  Yes

  No

  N/A

• Are floors adequately swept, mopped, vacuumed and free of slipping/tripping/fall hazards

  Yes

  No

  N/A

• Emergency exits clearly identified/unobstructed

  Yes

  No

  N/A

• Unapproved doors clearly marked “NOT AN EXIT”

  Yes

  No

  N/A

• All trash removed

  Yes

  No

  N/A

• Is the work and storage areas clean and orderly

  Yes

  No

  N/A

• First aid responders available for each shift

  Yes

  No

  N/A

• Are cabinet tops clean and not used for storage

  Yes

  No

  N/A

Signs and Posting

• Emergency evacuation plan is posted and up to date

  Yes

  No

  N/A

• Safety Alert's are posted including other sites

  Yes

  No

  N/A

• Safety Pyramid is up to date

  Yes

  No

  N/A

• Unsafe and Near miss report forms are readily available to all employees

  Yes

  No

  N/A

• Safety Policy is posted and up to date

  Yes

  No

  N/A

Emergency Medical

• Emergency contact information posted

  Yes

  No

  N/A

• First Aid supplies adequate and available

  Yes

  No

  N/A

• Bloodborne pathogens exposure kits available

  Yes

  No

  N/A

• Transportation available for injured worker plan in place

  Yes

  No

  N/A

Slip Trip and Fall Hazards

• Portable ladders equipped with non-slip feet. Metal ladders marked "DO NOT USE AROUND ELECTRICAL EQUIPMENT"

  Yes

  No

  N/A

• Work areas, aisle ways, and storage areas are orderly

  Yes

  No

  N/A

• Illumination adequate for normal conditions, emergency lighting in place

  Yes

  No

  N/A

• External walking, parking, and break areas free of potential hazard

  Yes

  No

  N/A

• Warning signs posted for wet floors and spills

  Yes

  No

  N/A

Hand Tools

• Power tools properly grounded/have safety power switch

  Yes

  No

  N/A

• Defective tools are removed from service

  Yes

  No

  N/A

• Proper guards are provided, tools electrically grounded or double insulated

  Yes

  No

  N/A

• There is a preventative maintenance/inspection program

  Yes

  No

  N/A

Fire Safety

• Portable fire extinguishers are mounted properly, accessible, and inspected /access unobstructed

  Yes

  No

  N/A

• Approved safety containers are used for flammable liquids & clearly marked

  Yes

  No

  N/A

• Combustible debris disposed of regularly

  Yes

  No

  N/A

• “No Smoking” area designated

  Yes

  No

  N/A

• Sprinkler system functional, inspected, and documented

  Yes

  No

  N/A

• Smoke/heat detectors functional and inspected

  Yes

  No

  N/A

• Minimum 18” clearance below sprinkler heads

  Yes

  No

  N/A

• Sprinkler valves locked open

  Yes

  No

  N/A

Electrical Hazards

• Machinery and equipment are grounded per code

  Yes

  No

  N/A

• Electrical panels have clear access

  Yes

  No

  N/A

• Electrical panels are clearly marked

  Yes

  No

  N/A

• Are all breaker boxes, junction boxes, electrical panels securely closed

  Yes

  No

  N/A

• Outlet, switches, and boxes have covers and labels

  Yes

  No

  N/A

• Permanent wiring in place – no extension cords

  Yes

  No

  N/A

• Exposure of overhead electrical lines controlled

  Yes

  No

  N/A

• Emergency stops and critical electrical controls are identified

  Yes

  No

  N/A

Material Handling Equipment

Material Handling Equipment

• Materials are neatly and safely stored

  Yes

  No

  N/A

• Containers used for storage are in good condition

  Yes

  No

  N/A

• Storage areas free from tripping hazards

  Yes

  No

  N/A

• Pallets and skids are inspected before use

  Yes

  No

  N/A

• Weight limits are clearly marked on shelving

  Yes

  No

  N/A

• Boxes over allowed lifting weight are marked

  Yes

  No

  N/A

• Shelving and platforms are in good condition

  Yes

  No

  N/A

Forklift Operations

• Observed operating at safe speeds

  Yes

  No

  N/A

• Observed safe loading and unloading practices

  Yes

  No

  N/A

• Equipped with back up alarms

  Yes

  No

  N/A

• Operators qualified and trained

  Yes

  No

  N/A

• Equipment inspected beginning of each shift

  Yes

  No

  N/A

• Seat belts worn properly

  Yes

  No

  N/A

• Mirrors installed at blind spots

  Yes

  No

  N/A

• Horns Operational

  Yes

  No

  N/A

Mechanical and Manual Handling and Storage

• Manual handling aids available and used

  Yes

  No

  N/A

• Weight limits are set for manual lifting, carrying, pushing, and pulling

  Yes

  No

  N/A

• Workers trained in proper lifting techniques and ergonomics

  Yes

  No

  N/A

Procedures

• There is a procedure for each task

  Yes

  No

  N/A

• Procedure includes safety requirements and personal protective equipment requirements

  Yes

  No

  N/A

Training (Verification of any training will be based on review of the training rosters)

• Personnel are trained in the task they are doing

  Yes

  No

  N/A

• There is a training matrix for each department with required training for each task

  Yes

  No

  N/A

• Employees are up to date in required training (task and safety )

  Yes

  No

  N/A

• Safety talks are being performed on a weekly basis

  Yes

  No

  N/A

• Safety alerts from all sites are reviewed

  Yes

  No

  N/A

• Initial training includes a thorough review of hazards and incidents associated with the task

  Yes

  No

  N/A

Risk Assessment

• Risk assessments have been completed for each task in the department

  Yes

  No

  N/A

• The risk assessment has been reviewed by the employees doing the task

  Yes

  No

  N/A

Machinery

• Lockout/tagout program in place, locks available, and employees trained

  Yes

  No

  N/A

• Hazardous areas painted bright colors

  Yes

  No

  N/A

• Guards are provided for “point of operation” of machinery

  Yes

  No

  N/A

• Clothing and hair restrictions are in place to prevent entanglement in machinery

  Yes

  No

  N/A

• Power transmission guards are in place

  Yes

  No

  N/A

• Noise exposures measured and documented

  Yes

  No

  N/A

• Warning labels displayed in obvious locations

  Yes

  No

  N/A

• Compressed air systems have pressure reduced to 30 PSI and are not used for cleaning clothes

  Yes

  No

  N/A

• Compressed air hoses have proper nozzles on them

  Yes

  No

  N/A

• Air hoses provided with safety latch to prevent accidental disconnect

  Yes

  No

  N/A

• Compressed gas cylinders are secured to prevent falling

  Yes

  No

  N/A

• Overhead hazards from equipment, conveyors, and process pipes are guarded below 7 feet from the door

  Yes

  No

  N/A

• Compressed gas cylinders are properly labeled to include if it is empty

  Yes

  No

  N/A

Chemicals

• Hazardous materials containers are properly labeled

  Yes

  No

  N/A

• Safety Data Sheets Available

  Yes

  No

  N/A

• Hazard Communication Training program in place

  Yes

  No

  N/A

• Smoking and eating prohibited in work areas where chemicals are used

  Yes

  No

  N/A

• Eye wash and emergency shower available, functional, inspected and documented

  Yes

  No

  N/A

Personal Protective Equipment

• Employees trained in the use and maintenance of PPE – training documented

  Yes

  No

  N/A

• PPE assessment performed and requirements in place

  Yes

  No

  N/A

• Hearing protecting utilized in required areas

  Yes

  No

  N/A

• Face and eye protection in place where needed

  Yes

  No

  N/A

• Safety shoe protection in place where needed

  Yes

  No

  N/A

• Protective clothing, gloves, aprons, boots, face shields, and goggles are used when handling hazardous materials

  Yes

  No

  N/A

Environmental Management System

• There is no evidence of broken lamps

  Yes

  No

  N/A

• Used rags, gloves, mats are kept in covered containers

  Yes

  No

  N/A

• There are no used batteries in the trash

  Yes

  No

  N/A

• Used batteries are recycled in the proper collection container

  Yes

  No

  N/A

• Waste oil, emulsion, spent light bulbs, etc are all dated with start accumulation date

  Yes

  No

  N/A

• All leaks and spills are properly contained

  Yes

  No

  N/A

Finish

• Notify manager of completion.

  Ok

  Not finished

Housekeeping

• Walkways maintained, aisle defined, uncluttered

  Yes

  No

  N/A

• Is storage maintained within the markings on the floor

  Yes

  No

  N/A

• Are floors adequately swept, mopped, vacuumed and free of slipping/tripping/fall hazards

  Yes

  No

  N/A

• Emergency exits clearly identified/unobstructed

  Yes

  No

  N/A

• Unapproved doors clearly marked “NOT AN EXIT”

  Yes

  No

  N/A

• Stairs free from material storage and debris

  Yes

  No

  N/A

• All trash removed

  Yes

  No

  N/A

• Is the work and storage areas clean and orderly

  Yes

  No

  N/A

• First aid responders available for each shift

  Yes

  No

  N/A

• Are cabinet tops clean and not used for storage

  Yes

  No

  N/A

Signs and Posting

• Emergency evacuation plan is posted and up to date

  Yes

  No

  N/A

• Safety Alert's are posted including other sites

  Yes

  No

  N/A

• Safety Pyramid is up to date

  Yes

  No

  N/A

• Unsafe and Near miss report forms are readily available to all employees

  Yes

  No

  N/A

• Safety Policy is posted and up to date

  Yes

  No

  N/A

Emergency Medical

• Emergency contact information posted

  Yes

  No

  N/A

• First Aid supplies adequate and available

  Yes

  No

  N/A

• Bloodborne pathogens exposure kits available

  Yes

  No

  N/A

• Transportation available for injured worker plan in place

  Yes

  No

  N/A

Slip Trip and Fall Hazards

• Stairways in good condition with handrails, treads, and risers in proper proportion and non-slip

  Yes

  No

  N/A

• Portable ladders equipped with non-slip feet. Metal ladders marked "DO NOT USE AROUND ELECTRICAL EQUIPMENT"

  Yes

  No

  N/A

• Work areas, aisle ways, and storage areas are orderly

  Yes

  No

  N/A

• Elevated areas have guardrails and toe boards

  Yes

  No

  N/A

• Illumination adequate for normal conditions, emergency lighting in place

  Yes

  No

  N/A

• External walking, parking, and break areas free of potential hazard

  Yes

  No

  N/A

• Warning signs posted for wet floors and spills

  Yes

  No

  N/A

• Antislip mats and flooring used where appropriate

  Yes

  No

  N/A

Fire Safety

• Portable fire extinguishers are mounted properly, accessible, and inspected /access unobstructed

  Yes

  No

  N/A

• Approved safety containers are used for flammable liquids & clearly marked

  Yes

  No

  N/A

• Bonding and grounding used with storage of flammable materials

  Yes

  No

  N/A

• Combustible debris disposed of regularly

  Yes

  No

  N/A

• “No Smoking” area designated

  Yes

  No

  N/A

• Sprinkler system functional, inspected, and documented

  Yes

  No

  N/A

• Smoke/heat detectors functional and inspected

  Yes

  No

  N/A

• Minimum 18” clearance below sprinkler heads

  Yes

  No

  N/A

• Sprinkler valves locked open

  Yes

  No

  N/A

Electrical Hazards

• Machinery and equipment are grounded per code

  Yes

  No

  N/A

• Electrical panels have clear access

  Yes

  No

  N/A

• Electrical panels are clearly marked

  Yes

  No

  N/A

• Are all breaker boxes, junction boxes, electrical panels securely closed

  Yes

  No

  N/A

• Outlet, switches, and boxes have covers and labels

  Yes

  No

  N/A

• Permanent wiring in place – no extension cords

  Yes

  No

  N/A

• Exposure of overhead electrical lines controlled

  Yes

  No

  N/A

• Emergency stops and critical electrical controls are identified

  Yes

  No

  N/A

• Appropriate electrical systems designed for hazardous location have been installed in spray booths and flammable liquid storage rooms

  Yes

  No

  N/A

Material Handling Equipment

Material Handling Equipment

• Materials are neatly and safely stored

  Yes

  No

  N/A

• Containers used for storage are in good condition

  Yes

  No

  N/A

• Storage areas free from tripping hazards

  Yes

  No

  N/A

• Pallets and skids are inspected before use

  Yes

  No

  N/A

• Weight limits are clearly marked on shelving

  Yes

  No

  N/A

• Boxes over allowed lifting weight are marked

  Yes

  No

  N/A

• Shelving and platforms are in good condition

  Yes

  No

  N/A

Forklift Operations

• Observed operating at safe speeds

  Yes

  No

  N/A

• Observed safe loading and unloading practices

  Yes

  No

  N/A

• Equipped with back up alarms

  Yes

  No

  N/A

• Operators qualified and trained

  Yes

  No

  N/A

• Equipment inspected beginning of each shift

  Yes

  No

  N/A

• Seat belts worn properly

  Yes

  No

  N/A

• Mirrors installed at blind spots

  Yes

  No

  N/A

• Horns Operational

  Yes

  No

  N/A

Mechanical and Manual Handling and Storage

• Workers trained in proper lifting techniques and ergonomics

  Yes

  No

  N/A

Procedures

• There is a procedure for each task

  Yes

  No

  N/A

• Procedure includes safety requirements and personal protective equipment requirements

  Yes

  No

  N/A

Training (Verification of any training will be based on review of the training rosters)

• Personnel are trained in the task they are doing

  Yes

  No

  N/A

• There is a training matrix for each department with required training for each task

  Yes

  No

  N/A

• Employees are up to date in required training (task and safety )

  Yes

  No

  N/A

• Safety talks are being performed on a weekly basis

  Yes

  No

  N/A

• Safety alerts from all sites are reviewed

  Yes

  No

  N/A

• Initial training includes a thorough review of hazards and incidents associated with the task

  Yes

  No

  N/A

Risk Assessment

• Risk assessments have been completed for each task in the department

  Yes

  No

  N/A

• The risk assessment has been reviewed by the employees doing the task

  Yes

  No

  N/A

Machinery

• Lockout/tagout program in place, locks available, and employees trained

  Yes

  No

  N/A

• Hazardous areas painted bright colors

  Yes

  No

  N/A

• Guards are provided for “point of operation” of machinery

  Yes

  No

  N/A

• Clothing and hair restrictions are in place to prevent entanglement in machinery

  Yes

  No

  N/A

• Power transmission guards are in place

  Yes

  No

  N/A

• Noise exposures measured and documented

  Yes

  No

  N/A

• Warning labels displayed in obvious locations

  Yes

  No

  N/A

• Compressed air systems have pressure reduced to 30 PSI and are not used for cleaning clothes

  Yes

  No

  N/A

• Compressed air hoses have proper nozzles on them

  Yes

  No

  N/A

• Air hoses provided with safety latch to prevent accidental disconnect

  Yes

  No

  N/A

• Welding equipment in good condition

  Yes

  No

  N/A

• Compressed gas cylinders are secured to prevent falling

  Yes

  No

  N/A

• Overhead hazards from equipment, conveyors, and process pipes are guarded below 7 feet from the door

  Yes

  No

  N/A

• Compressed gas cylinders are properly labeled to include if it is empty

  Yes

  No

  N/A

Chemicals

• Hazardous materials containers are properly labeled

  Yes

  No

  N/A

• Safety Data Sheets Available

  Yes

  No

  N/A

• Hazard Communication Training program in place

  Yes

  No

  N/A

• Smoking and eating prohibited in work areas where chemicals are used

  Yes

  No

  N/A

• Eye wash and emergency shower available, functional, inspected and documented

  Yes

  No

  N/A

Personal Protective Equipment

• Employees trained in the use and maintenance of PPE – training documented

  Yes

  No

  N/A

• PPE assessment performed and requirements in place

  Yes

  No

  N/A

• Hearing protecting utilized in required areas

  Yes

  No

  N/A

• Face and eye protection in place where needed

  Yes

  No

  N/A

• Safety shoe protection in place where needed

  Yes

  No

  N/A

• Protective clothing, gloves, aprons, boots, face shields, and goggles are used when handling hazardous materials

  Yes

  No

  N/A

Environmental Management System

• There is no evidence of broken lamps

  Yes

  No

  N/A

• Used rags, gloves, mats are kept in covered containers

  Yes

  No

  N/A

• There are no used batteries in the trash

  Yes

  No

  N/A

• Used batteries are recycled in the proper collection container

  Yes

  No

  N/A

• Waste oil, emulsion, spent light bulbs, etc are all dated with start accumulation date

  Yes

  No

  N/A

• All leaks and spills are properly contained

  Yes

  No

  N/A

Finish

• Notify manager of completion.

  Ok

  Not finished

Housekeeping

• Walkways maintained, aisle defined, uncluttered

  Yes

  No

  N/A

• Are floors adequately swept, mopped, vacuumed and free of slipping/tripping/fall hazards

  Yes

  No

  N/A

• Emergency exits clearly identified/unobstructed

  Yes

  No

  N/A

• Unapproved doors clearly marked “NOT AN EXIT”

  Yes

  No

  N/A

• All trash removed

  Yes

  No

  N/A

• Is the work and storage areas clean and orderly

  Yes

  No

  N/A

• First aid responders available for each shift

  Yes

  No

  N/A

• Are cabinet tops clean and not used for storage

  Yes

  No

  N/A

Signs and Posting

• Emergency evacuation plan is posted and up to date

  Yes

  No

  N/A

• Safety Alert's are posted including other sites

  Yes

  No

  N/A

• Safety Pyramid is up to date

  Yes

  No

  N/A

• Unsafe and Near miss report forms are readily available to all employees

  Yes

  No

  N/A

• Safety Policy is posted and up to date

  Yes

  No

  N/A

Emergency Medical

• Emergency contact information posted

  Yes

  No

  N/A

• First Aid supplies adequate and available

  Yes

  No

  N/A

• Bloodborne pathogens exposure kits available

  Yes

  No

  N/A

• Transportation available for injured worker plan in place

  Yes

  No

  N/A

Slip Trip and Fall Hazards

• Portable ladders equipped with non-slip feet. Metal ladders marked "DO NOT USE AROUND ELECTRICAL EQUIPMENT"

  Yes

  No

  N/A

• Work areas, aisle ways, and storage areas are orderly

  Yes

  No

  N/A

• Illumination adequate for normal conditions, emergency lighting in place

  Yes

  No

  N/A

• External walking, parking, and break areas free of potential hazard

  Yes

  No

  N/A

• Warning signs posted for wet floors and spills

  Yes

  No

  N/A

• Antislip mats and flooring used where appropriate

  Yes

  No

  N/A

Hand Tools

• Power tools properly grounded/have safety power switch

  Yes

  No

  N/A

• Defective tools are removed from service

  Yes

  No

  N/A

• Proper guards are provided, tools electrically grounded or double insulated

  Yes

  No

  N/A

• There is a preventative maintenance/inspection program

  Yes

  No

  N/A

Fire Safety

• Portable fire extinguishers are mounted properly, accessible, and inspected /access unobstructed

  Yes

  No

  N/A

• Approved safety containers are used for flammable liquids & clearly marked

  Yes

  No

  N/A

• Bonding and grounding used with storage of flammable materials

  Yes

  No

  N/A

• Combustible debris disposed of regularly

  Yes

  No

  N/A

• “No Smoking” area designated

  Yes

  No

  N/A

• Sprinkler system functional, inspected, and documented

  Yes

  No

  N/A

• Smoke/heat detectors functional and inspected

  Yes

  No

  N/A

• Minimum 18” clearance below sprinkler heads

  Yes

  No

  N/A

• Sprinkler valves locked open

  Yes

  No

  N/A

Electrical Hazards

• Machinery and equipment are grounded per code

  Yes

  No

  N/A

• Electrical panels have clear access

  Yes

  No

  N/A

• Electrical panels are clearly marked

  Yes

  No

  N/A

• Are all breaker boxes, junction boxes, electrical panels securely closed

  Yes

  No

  N/A

• Outlet, switches, and boxes have covers and labels

  Yes

  No

  N/A

• Permanent wiring in place – no extension cords

  Yes

  No

  N/A

• Exposure of overhead electrical lines controlled

  Yes

  No

  N/A

• Emergency stops and critical electrical controls are identified

  Yes

  No

  N/A

• Appropriate electrical systems designed for hazardous location have been installed in spray booths and flammable liquid storage rooms

  Yes

  No

  N/A

Material Handling Equipment

• Materials are neatly and safely stored

  Yes

  No

  N/A

• Containers used for storage are in good condition

  Yes

  No

  N/A

• Storage areas free from tripping hazards

  Yes

  No

  N/A

• Boxes over allowed lifting weight are marked

  Yes

  No

  N/A

• Shelving and platforms are in good condition

  Yes

  No

  N/A

Mechanical and Manual Handling and Storage

• Manual handling aids available and used

  Yes

  No

  N/A

• Weight limits are set for manual lifting, carrying, pushing, and pulling

  Yes

  No

  N/A

• Workers trained in proper lifting techniques and ergonomics

  Yes

  No

  N/A

Procedures

• There is a procedure for each task

  Yes

  No

  N/A

• Procedure includes safety requirements and personal protective equipment requirements

  Yes

  No

  N/A

Training (Verification of any training will be based on review of the training rosters)

• Personnel are trained in the task they are doing

  Yes

  No

  N/A

• There is a training matrix for each department with required training for each task

  Yes

  No

  N/A

• Employees are up to date in required training (task and safety )

  Yes

  No

  N/A

• Safety talks are being performed on a weekly basis

  Yes

  No

  N/A

• Safety alerts from all sites are reviewed

  Yes

  No

  N/A

• Initial training includes a thorough review of hazards and incidents associated with the task

  Yes

  No

  N/A

Risk Assessment

• Risk assessments have been completed for each task in the department

  Yes

  No

  N/A

• The risk assessment has been reviewed by the employees doing the task

  Yes

  No

  N/A

Machinery

• Lockout/tagout program in place, locks available, and employees trained

  Yes

  No

  N/A

• Hazardous areas painted bright colors

  Yes

  No

  N/A

• Guards are provided for “point of operation” of machinery

  Yes

  No

  N/A

• Clothing and hair restrictions are in place to prevent entanglement in machinery

  Yes

  No

  N/A

• Power transmission guards are in place

  Yes

  No

  N/A

• Warning labels displayed in obvious locations

  Yes

  No

  N/A

• Compressed air hoses have proper nozzles on them

  Yes

  No

  N/A

• Air hoses provided with safety latch to prevent accidental disconnect

  Yes

  No

  N/A

• Compressed gas cylinders are secured to prevent falling

  Yes

  No

  N/A

• Overhead hazards from equipment, conveyors, and process pipes are guarded below 7 feet from the door

  Yes

  No

  N/A

• Compressed gas cylinders are properly labeled to include if it is empty

  Yes

  No

  N/A

Chemicals

• Hazardous materials containers are properly labeled

  Yes

  No

  N/A

• Safety Data Sheets Available

  Yes

  No

  N/A

• Hazard Communication Training program in place

  Yes

  No

  N/A

• Smoking and eating prohibited in work areas where chemicals are used

  Yes

  No

  N/A

• Eye wash and emergency shower available, functional, inspected and documented

  Yes

  No

  N/A

Personal Protective Equipment

• Employees trained in the use and maintenance of PPE – training documented

  Yes

  No

  N/A

• PPE assessment performed and requirements in place

  Yes

  No

  N/A

• Hearing protecting utilized in required areas

  Yes

  No

  N/A

• Face and eye protection in place where needed

  Yes

  No

  N/A

• Safety shoe protection in place where needed

  Yes

  No

  N/A

• Protective clothing, gloves, aprons, boots, face shields, and goggles are used when handling hazardous materials

  Yes

  No

  N/A

Environmental Management System

• There is no evidence of broken lamps

  Yes

  No

  N/A

• Used rags, gloves, mats are kept in covered containers

  Yes

  No

  N/A

• There are no used batteries in the trash

  Yes

  No

  N/A

• Used batteries are recycled in the proper collection container

  Yes

  No

  N/A

• Waste oil, emulsion, spent light bulbs, etc are all dated with start accumulation date

  Yes

  No

  N/A

• All leaks and spills are properly contained

  Yes

  No

  N/A

Finish

• Notify manager of completion.

  Ok

  Not finished

Housekeeping

• Walkways maintained, aisle defined, uncluttered

  Yes

  No

  N/A

• Is storage maintained within the markings on the floor

  Yes

  No

  N/A

• Are floors adequately swept, mopped, vacuumed and free of slipping/tripping/fall hazards

  Yes

  No

  N/A

• Emergency exits clearly identified/unobstructed

  Yes

  No

  N/A

• Unapproved doors clearly marked “NOT AN EXIT”

  Yes

  No

  N/A

• Stairs free from material storage and debris

  Yes

  No

  N/A

• All trash removed

  Yes

  No

  N/A

• Is the work and storage areas clean and orderly

  Yes

  No

  N/A

• First aid responders available for each shift

  Yes

  No

  N/A

• Are cabinet tops clean and not used for storage

  Yes

  No

  N/A

Signs and Posting

• Emergency evacuation plan is posted and up to date

  Yes

  No

  N/A

• Safety Alert's are posted including other sites

  Yes

  No

  N/A

• Safety Pyramid is up to date

  Yes

  No

  N/A

• Unsafe and Near miss report forms are readily available to all employees

  Yes

  No

  N/A

• Safety Policy is posted and up to date

  Yes

  No

  N/A

Emergency Medical

• Emergency contact information posted

  Yes

  No

  N/A

• First Aid supplies adequate and available

  Yes

  No

  N/A

• Bloodborne pathogens exposure kits available

  Yes

  No

  N/A

• Transportation available for injured worker plan in place

  Yes

  No

  N/A

Slip Trip and Fall Hazards

• Stairways in good condition with handrails, treads, and risers in proper proportion and non-slip

  Yes

  No

  N/A

• Portable ladders equipped with non-slip feet. Metal ladders marked "DO NOT USE AROUND ELECTRICAL EQUIPMENT"

  Yes

  No

  N/A

• Work areas, aisle ways, and storage areas are orderly

  Yes

  No

  N/A

• Elevated areas have guardrails and toe boards

  Yes

  No

  N/A

• Illumination adequate for normal conditions, emergency lighting in place

  Yes

  No

  N/A

• External walking, parking, and break areas free of potential hazard

  Yes

  No

  N/A

• Warning signs posted for wet floors and spills

  Yes

  No

  N/A

• Antislip mats and flooring used where appropriate

  Yes

  No

  N/A

Hand Tools

• Power tools properly grounded/have safety power switch

  Yes

  No

  N/A

• Defective tools are removed from service

  Yes

  No

  N/A

• Proper guards are provided, tools electrically grounded or double insulated

  Yes

  No

  N/A

• There is a preventative maintenance/inspection program

  Yes

  No

  N/A

Fire Safety

• Portable fire extinguishers are mounted properly, accessible, and inspected /access unobstructed

  Yes

  No

  N/A

• Approved safety containers are used for flammable liquids & clearly marked

  Yes

  No

  N/A

• Bonding and grounding used with storage of flammable materials

  Yes

  No

  N/A

• Combustible debris disposed of regularly

  Yes

  No

  N/A

• “No Smoking” area designated

  Yes

  No

  N/A

• Sprinkler system functional, inspected, and documented

  Yes

  No

  N/A

• Smoke/heat detectors functional and inspected

  Yes

  No

  N/A

• Minimum 18” clearance below sprinkler heads

  Yes

  No

  N/A

• Sprinkler valves locked open

  Yes

  No

  N/A

Electrical Hazards

• Machinery and equipment are grounded per code

  Yes

  No

  N/A

• Electrical panels have clear access

  Yes

  No

  N/A

• Electrical panels are clearly marked

  Yes

  No

  N/A

• Are all breaker boxes, junction boxes, electrical panels securely closed

  Yes

  No

  N/A

• Outlet, switches, and boxes have covers and labels

  Yes

  No

  N/A

• Permanent wiring in place – no extension cords

  Yes

  No

  N/A

• Exposure of overhead electrical lines controlled

  Yes

  No

  N/A

• Emergency stops and critical electrical controls are identified

  Yes

  No

  N/A

• Appropriate electrical systems designed for hazardous location have been installed in spray booths and flammable liquid storage rooms

  Yes

  No

  N/A