Title Page

  • Facility Name
  • Conducted on

Page 1 - OSHA Records

Specific Confined Space Program (1910.146)

  • Facility Name

  • Hazard Evaluation of Each Space

  • Training Certification

Lockout/Tag (1910.147)

  • Annual Lockout Procedure Inspection (App A)

  • Specific MES Lockout Forms Masters (App B)

PPE (1910.132)

  • Hazard Assesments

  • Training Certification

  • Exposure Control Plan (1910.1030)

  • First Report of Injuries (Keep 5 Yrs)

  • Incident Investigation Report

  • OSHA 300 (3 yrs ok, 5 on hand)(1904)

  • Written Housekeeping Plan (1910.272/GMO for FDA)

  • Noise Survey 1910.95

  • OSHA Fed/State posters Posted

  • MSDS binder Current (1910.1200)

  • Location Safety Manual Current & Complete

Page 2 - Safety Equipment Inspections

Passenger Elevator Inspections (Caged Manlift)

  • Monthly Inspection

  • Annual Outside Inspection

  • Portable Electric Tool Inspection (Q)

  • Explosion Vent Insp. (6 mo)

Fall protection Equipment Insp. (6 Mo.)

  • Harness, Lanyard, and Self Retractable Blcok

  • Overhead Fall System Integrity

Fire Extinguisher Insp. (1910.157)

  • Monthly

  • Annual (Copies of Outside Insp.)

  • Lifting Device Insp. (6 Mo.) hoists, come-alongs, web and chain slings)

  • Portable Ladder Inspections (1910.27)(A)

  • Dryer System Controls and Fuel System (A)

  • Annual Electrical Equipment INSP.(A)

  • BBP Kits In Place and Complete

  • BE Safety Devices (motion/Speed switch, Rub Blocks, Bearing Temp, Inspection Doors)

Page 3 - Maintenance

  • Equipment History Cards

  • PM Records (1910.272) (Recod On Work List)!

  • Lubrication Records (1910.272) (Recorded)!

  • PM Manual Up To Date

  • To-Do-List of Work Needed/Done With Action Notations!

  • Equipment Recorded Card (Listing Up-to-date)

Page 4 - Other

  • Electric Switch Gear Inspection (Cleaned & Infrared) (2 yr)

  • New Employee Orientation and 1 Month Evaluation

Fumigation (EPA Rules) (Re: Fum Mgmt. Plan)

  • Check Lists

  • inventory Sheets

  • Characterization Study (See Fum Mgmt Plan)

  • Safety Meeting Minutes (Monthly)

  • Pesticide Records Usage (EPA & USDA)

Page 5 - Permits

  • Bin Entry

  • Blowdown

  • Confined Space

  • Hot Work

  • Lockout Procedure Inspections (A)

Notes:

  • Please Place Any Comments Below:

  • Full Name and Signature Below:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.