Reliant Safety Solutions,LLC

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Shop Personnel Onsite During Inspection

Previous Inspection

• Has the last inspection been reviewed?

  Yes

  No

  N/A

• Are there any outstanding safety deficiencies?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Administrative / Site Records

• Did shop Foreman accompany inspector?

  Yes

  No

  N/A

• Are all Safety/GHS/Hazcom/Emergency Programs on site?

  Yes

  No

  N/A

• Emergency contact numbers posted?

  Yes

  No

  N/A

• OSHA and Federal/state/local posters posted in conspicuous place?

  Yes

  No

  N/A

• Company JSA's completed prior to work.

  Yes

  No

  N/A

• Are safety meetings held and documented?

  Yes

  No

  N/A

• Employee training documentation available?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

General

• Are hazardous materials stored and labeled properly?

  Yes

  No

  N/A

• Are SDS available to all employees?

  Yes

  No

  N/A

• Are restrooms clean?

  Yes

  No

  N/A

• Lighting ok?

  Yes

  No

  N/A

• Hand wash stations properly labeled?

  Yes

  No

  N/A

• First Aid kit available and properly stocked?

  Yes

  No

  N/A

• Emergency eyewash station onsite?

  Yes

  No

  N/A

• Drinking water stations have disposable cups and waste containers available?

  Yes

  No

  N/A

• Pest control?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Personal Protective Equipment

• Hard hats worn properly and in good condition?

  Yes

  No

  N/A

• Protective clothing worn?

  Yes

  No

  N/A

• Proper ANSI Z87 safety glasses worn by employees?

  Yes

  No

  N/A

• Double eye protection, face shields when grinding worn?

  Yes

  No

  N/A

• Proper work boots worn by employess?

  Yes

  No

  N/A

• Approved and effective ear protection used?

  Yes

  No

  N/A

• Gloves used when required?

  Yes

  No

  N/A

• Respiratory protection used where required? Are workers trained?

  Yes

  No

  N/A

• Respirators properly cleaned and stored when not in use?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Housekeeping

• Walkways clear of material and debris?

  Yes

  No

  N/A

• Trash cans available where required and empty?

  Yes

  No

  N/A

• Equipment, hoses,ect.... That aren't in use, are they properly stored?

  Yes

  No

  N/A

• Exits signs visible and unobstructed?

  Yes

  No

  N/A

• Is the parts department area clean and uncluttered?

  Yes

  No

  N/A

• Material storage areas kept organized and clean?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Fire Protection

• Fire extinguishers located in area and visible?

  Yes

  No

  N/A

• Fire extinguishers charged and have a current annual inspection?

  Yes

  No

  N/A

• Flammable materials stored properly?

  Yes

  No

  N/A

• UL - Approved fuel containers used for storage of flammable liquids?

  Yes

  No

  N/A

• No smoking signs posted by fuel area?

  Yes

  No

  N/A

• All containers (cans, drums, fuel tanks, gas cylinders, ect) are clearly marked with contents?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Yard

• Material stored neatly and stacked properly?

  Yes

  No

  N/A

• Clear walkways maintained around storage areas?

  Yes

  No

  N/A

• Storage areas kept free of trash and debris?

  Yes

  No

  N/A

• Yard maintenance (grass, weeds) under control?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Tool Room

• Is tool room area clear of trash?

  Yes

  No

  N/A

• Is walk way clear?

  Yes

  No

  N/A

• Inventory properly stacked?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Warehouse

• Is area clear of trash?

  Yes

  No

  N/A

• Is walkways clear for safe walking?

  Yes

  No

  N/A

• Inventory properly stacked?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Paint Room

• Double containment being used?

  Yes

  No

  N/A

• Flammable storage cabinets being used?

  Yes

  No

  N/A

• Spilled paint cleaned up?

  Yes

  No

  N/A

• Proper ventilation being used?

  Yes

  No

  N/A

• Proper lighting being used?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Crane and Rigging

• Overhead crane inspected?

  Yes

  No

  N/A

• Overhead crane hook inspected, cables unfrayed?

  Yes

  No

  N/A

• Safety latches working?

  Yes

  No

  N/A

• Are riggers and signal person trained/qualified?

  Yes

  No

  N/A

• Slings, and chains, hooks and eyes, have no evidence of damage, defects, or excessive wear?

  Yes

  No

  N/A

• Chains inspected and have identification tag stating size, grade, rated capacity and manufacturer?

  Yes

  No

  N/A

• Are labels/tags legible on all rigging equipment?

  Yes

  No

  N/A

• Shackles free of damaged such as bent, twisted, distorted, stretched, elongated, cracked, nicks, pitting and corrosion?

  Yes

  No

  N/A

• Wire ropes/slings/chains/ inspections are current?<br>

  Yes

  No

  N/A

• Tag lines used to control the load?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Fall Protection

• Are stairways properly protected & used?

  Yes

  No

  N/A

• Top rail height at 42 inches - no more than 3 inches of deflection?

  Yes

  No

  N/A

• Mid-rail at proper height of 19 inches?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Hand and Power Tools & Machine Guarding

• Guards in place where required?

  Yes

  No

  N/A

• Power tools grounded properly?

  Yes

  No

  N/A

• Power tools cords in good condition?

  Yes

  No

  N/A

• Broken or defective tools taken out of service and tagged?

  Yes

  No

  N/A

• Proper tools being used for the correct task?

  Yes

  No

  N/A

• Hand tools proper maintained and inspected before use?

  Yes

  No

  N/A

• All compressed air equipment used is properly regulated?

  Yes

  No

  N/A

• Airlines/hoses secured to prevent whipping with cotter pin or tie wire?

  Yes

  No

  N/A

• Air hoses in good condition?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Welding and Cutting

• Compressed gas cylinders stored and secured properly?

  Yes

  No

  N/A

• Oxygen cylinders stored separately from fuel gas cylinders?

  Yes

  No

  N/A

• Cylinders equipped with safety caps when not in use?

  Yes

  No

  N/A

• Flash backs installed on torch or gauges?

  Yes

  No

  N/A

• Regulators and gauges free of damage and working properly?

  Yes

  No

  N/A

• Screens, shields, or eye protection provided and used to protect personnel from welding operations.

  Yes

  No

  N/A

• Welding lead free of damage and repairs with a minimum distance of 10 feet from electrode holder?

  Yes

  No

  N/A

• Proper welding lead material (electric tape, heat shrink, ect) used for repairs?

  Yes

  No

  N/A

• Pre-Heaters in safe condition. No leaks/Knobs?

  Yes

  No

  N/A

• Gas Welding machine properly ventilated to prevent gas build up?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Electrical

• GFCI's in use?

  Yes

  No

  N/A

• Electrical equipment grounded properly?

  Yes

  No

  N/A

• Electrical 3 ways used properly?

  Yes

  No

  N/A

• Extension cords free of damage (nicks, cuts, wear)?

  Yes

  No

  N/A

• Extension cords protected against accidental damage and kept clear of work spaces, walkways, ect. to prevent tripping or falling hazards?

  Yes

  No

  N/A

• Lock out - Tag out in place where required?

  Yes

  No

  N/A

• All panel boxes closed?

  Yes

  No

  N/A

• Do all boxes/panels have covers & are circuits labeled?

  Yes

  No

  N/A

• 3 feet clearance in front of panels?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Ladders

• Extension ladders being used correctly?

  Yes

  No

  N/A

• A-Frame portable ladders being used correctly?

  Yes

  No

  N/A

• Ladders properly maintained and stored?

  Yes

  No

  N/A

• Stickers/labels or legible and visible on all ladders?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Scaffolds

• Is scaffold competent person and scaffold users properly trained?

  Yes

  No

  N/A

• Are all scaffold frames/planks/parts free of damage & defects?

  Yes

  No

  N/A

• Are walk/work planks properly installed & set?

  Yes

  No

  N/A

• Are guardrails properly installed & used?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Forklift Operations

• Employee qualified to operate forklift?

  Yes

  No

  N/A

• Proper forklift inspection completed before use?

  Yes

  No

  N/A

• Is forklift properly maintained and inspected?

  Yes

  No

  N/A

• Seat belt worn when operating forklift?

  Yes

  No

  N/A

• Are forks on the ground when parked?

  Yes

  No

  N/A

• Are parts/equipment free from damage?

  Yes

  No

  N/A

• Are all operations performed at least 10 feet from overhead power lines?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Notes and Comments

• Report conclusion including any recommendations.

Signature

• On site representative

  Sign

• Auditor's signature

  Sign