• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Management Commitment


  • Safety policy is written, posted and reinforced on a regular basis. (Verify)

  • Written Policy is explained to new employees in orientation.

  • Employees understand written policy. (Survey Employees)

  • Is safety reviewed with all employees at plant meetings. (Documentation)


  • Goals are documented and published to employees.


  • Annual Safety review meeting is held with senior staff.

  • Safety Manager feels there are adequate resources to include support persons, maintenance support, training resources and equipment.

  • A trained back up person for the Safety Manager has been trained & identified.


  • Annual performance reviews include safety performance for all employees. (Verify HR files)

  • Accountability system is in place that measures and drives accountability for injury elimination.

  • A progressive discipline system is in place to address unsafe behaviors up to full dismissal. The accountability must align with the seriousness of the unsafe act or behavior.

Contractor Safety

  • Verify Contractor Service Agreements are available and up to date.

  • Process in place where Safety Manager is provided notification of all contractors that work on premises.

  • Initial Site specific safety orientation is given to new contractors prior to their working on site with documentation of such training.

  • Site specific safety orientation includes: Confined Space Awareness, Hot Work Permit Program, Hazardous Materials Identification, P.P.E. requirements: Lockout/Tagout Program, Tobacco Use Policy,Emergency Alarm System: Examine Training Records.

Management Involvement

  • Managers routinely emphasize safety and health as a company value. (Examples)

  • Managers regularly discuss worker safety and health at staff and employee meetings.

  • Managers attending and participating in safety committee meetings.

  • Managers do frequent "walk arounds" of facility, commenting on effective or ineffective safety and health practices observed.

  • Managers ensure employee and management training at appropriate times and frequency to minimize the potential for injuries or illness in the workplace.

Business Unit Manager

  • Review Organization Chart. Does Safety Environmental Manager report to Business Unit Manager.

  • Does Business Unit Manager complete Message to President report for lost time injuries within 7 days.

  • Business Unit Manager participates in injury/incident assessment process.

  • Business Unit Manager has completed safety orientation training.

  • The location has a No tolerance Policy in place (North America) and the ongoing awareness level remains adequate. Interview employees for effectiveness. Key areas to sustain awareness can include : <br>* assure the policy has been added to the New Employee Orientation training <br>* add the policy statement to the annual lockout/ragout audits where the employee signs off and reviews during the audits<br>* add the policy to the lockout/ragout, confined space and electrical safety plans<br>* review it at least annually in one of the plan wide communication meetings<br>* include it as an employee interview question during quarterly audits<br>* include it in any safety talks relative to the 3 areas

Return to Work

  • A return to work program is identified and used to rehabilitate injured employees

Employee Involvement

  • A safety team is identified

  • All areas are represented, including the office areas.

  • Safety team meets on regular basis

  • Documentation and action plans exist from safety team meetings

  • Safety Team members participate in injury assessments

  • Safety Team members help develop goals

  • A formal system exists for safety suggestions and follow up

Worksite Analysis

Job Hazard Analysis

  • Standardized comprehensive Job Hazard Analysis are utilized

  • Job Hazardous Analyses are stored on a server electronically and backed up daily

  • All new equipment or processes have JHAs performed prior to use (show examples)

Job Safety Procedures

  • Every job or operation has a Job Safety Procedure associated with it

  • All employees have access to Job Safety Procedures

  • Safety team members are part of Job Safety Procedures creation


  • Trend analysis is used to measure, monitor and share results with Management and Employees on periodic basis

  • Employees with multiple injuries are measured and a process is in place to address this challenge

  • A First Aid Log is logged and tracked for trend information

Audit Process

  • An audit system is used for conducting periodic general hazard assessments that includes written reports of findings and tracking hazards correction with closure dates. State the frequency rate.

  • A written industrial hygiene plan is in place.

  • Quarterly internal assessments are performed to determine the assessment rating (red, yellow or green) and the overall score.

  • Government agencies are invited to audit facility and make recommendations.<br>

  • All chemicals are approved before being introduced into the worksite.

Industrial Hygiene

  • Industrial Hygiene testing is performed as required. This includes retesting when applicable.

  • Industrial Hygiene recommendation and test results are shared with employees. Including annual hearing tests.

  • All corrective actions for Industrial Hygiene and reports are followed and tracked to completion.

  • Are you maintaining a log of occupational injuries and illnesses.

  • All workplace injuries or illnesses have a formal injury report associated with it.

  • Are you retaining the logs for the past 5 years.

Injury Reporting

  • Are you summarizing the previous year's records, and then posting this summary in the workplace from February 1 - April 30 (U.S. requirement).

  • Are required posters displayed appropriately.

  • Injuries are reported in 24 hours or less - initial.

Hazard Prevention and Control

Lead Measures

  • Lead measures on the Safety Scorecard show sustainable and continuous effectiveness.

Planning Matrix

  • A 12 month Safety Planning matrix exists listing requirements (above the training matrix).

Behavior Based Safety Process

  • Does the location utilize a comprehensive Behavior Based Safety Process.

  • Does Management full support through engagement (state how).

  • Has Training been given to all areas; management, supervisors, employees, safety team members.

  • Is there a designated Site Champion that has been certfied.

  • Has a cultural perception survey been completed.

  • Have the "Keys for Success' been completed by interviewing employees that have worked for extended periods without injury.

  • Have the behavioral challenges been identified by reviewing past injuries, near misses, first aid logs and other other indicators of challenges.

  • Have the key behavioral challenges been formally identified following the "Keys for Success" and the "challenges".

  • Has a social (24X7) responsibilities program been implemented to address off the job injuries.

  • Has employee ownership been established by taking the process to the local department level, identifying and displaying a local "lead" metric, and are the mitigating keys properly displayed.

  • Is behavioral reinforcement obvious in the local departments or through incentives?

  • Has sustainability factors been determined, monitored, measured and reviews held with management?

  • Have outside resources been utilized to assure the effectiveness of the program, such as corporate support.

Local Emergency Response

  • Local Emergency Response Team (LERT) is identified and kept current and up to date.

  • The LERT meets on quarterly basis for review and training. Specify last training date.

  • Minutes of LERT meetings are kept with actions steps identified and completed.

  • Emergency telephone numbers for all employees are reviewed and kept up to date.

  • Business Unit has Emergency Response Number at Corporate.

  • Annual evacuation / take shelter/ intruder drills have been conducted at least annually for all shifts (Documentation).

  • Following the annual emergency training documented results and improvements are performed.

  • Survey employees for knowledge of procedures.

  • Fire department has toured the facility in the past 3 year period.

  • Does your LERT verify with emergency responders to alarms the listing of persons to call if an alarm is triggered from the facility. Is the list up to date.

  • Certified emergency first aid personnel are available to all persons on all shifts.

  • Have all employees with potential exposure to Blood Borne Pathogens been given the opportunity to take Hepatitis B vaccine. Those not receiving the vaccine must sign a declination form. Verify.

  • This business unit provides Automatic External Defibrillator (AED) program for employees.

  • Are there Bomb Threat procedures and are those responsible to receive incoming calls trained.


  • Business Unit has written "Ergonomics" program.

  • Ergonomics program includes training for set up engineer for job set ups.

  • A history of ergonomic improvements is being documented.

Near Miss Program

  • A near miss program is in place that is active, items are formally tracked, trended and risks mitigated.

Written Plans

  • All Safety required written plans including Government plans are in place, implemented, reviewed once every three years, or when a new Safety Manager is appointed. Verify each of the following required plans that pertains:<br><br>____ Blood Borne Pathogen ____ Hazard Communications ____ Electrical<br><br>____ Combustible Dust ____ Hearing Conservation ____ Emergency Action<br><br>____ Confined Spaces ____ Hot Work ____ Fall Protection<br><br>____ Contractor Safety ____ Industrial Hygiene ____ Lockout Tag Out<br><br>____ Personal Protective Equipment ____ Respirator ____ Tobacco<br>

  • Only certified drivers operate company owned vehicles and all certified drivers are recertified every three years (U.S. locations only) Effective March 1, 2009.

Early Intervention

  • Early intervention process is in place for repetitive strain challenges. A resource is used to address such challenges.

Maintenance Support

  • A system is in place for preventive - predictive (PM) maintenance to prevent workplace equipment from becoming hazardous. Included in the PM checks are items such as machine guards, emergency lighting, etc.

  • A system exists for initiating and tracking hazard correction in timely manner is in place for the maintenance department. This includes a corrective action process.


  • All files are well organized. The standardized filing system is followed.

Safety Training


  • Verify that all required training has been completed which may include:<br><br>____ Emergency Action ____ Machine Guarding<br><br>____ Blood Borne Pathogens ____ Personal Protective Equipment<br><br>____ Combustible Dust ____ Respirator (if applicable)<br><br>____ Confined Spaces ____ Safe Driving<br><br>____ Electrical ____ HAZWOPER (including DOT 126, 181, 232)<br><br>____ Fall Protection ____ Bomb Threat<br><br>____ Fire Extinguisher ____ Ergonomics<br><br>____ Forklift ____ First Aid<br><br>____ Hazard Communications ____ Indexible Tooling<br><br>____ Hearing Conservation ____ Welding<br><br>____ Hot Work ____ Industrial Hygiene<br><br>____ Lockout Tag Out

  • An advanced safety training program exist for supervision.

  • Safety Training is documented with record keeping process . (Audit)

  • Temporary work employees receive immediate safety orientation prior to introduction to work.

  • A new Safety Manager is given opportunity to attend training from such resources as National Safety Council, Voluntary Protection Program, American Society of Safety Engineers, FM Global, Liberty Mutual and Government provided programs or requirements.

  • Safety Manager is a member of a professional safety organization.


Permit Required Confined Spaces

  • Does the location use the 'standardized' confined space 'plan'?

  • Are there Permit Required Confined Spaces at this location and are they identified in the written Confined Space Plan?

  • Is each Permit Required Confined Space marked with appropriate sign(s)?

  • Does the location "enter" the confined spaces? If no, is that documented in the plan and do we assure that contractors follow correct procedures?

  • Has each Permit Required Confined Space had a formal risk analysis performed on it?

  • Is there a dedicated Job Safety Procedure for each separate Permit Required Confined Space and is each JSP posted at the space? Does each JSP note what hazard could be 'introduced' into the space (such as welding) and the steps required to manage risk? Forced air must be used if welding is conducted within the space.

  • Are only qualified and trained employees entering the spaces (verify training)? Does the plan list those employees?

  • Only a selective number of properly trained and qualified contractors perform Permit Required Confined Space entry? And the contractor follow all Permit Required Confined Space.

  • Internal Rescue: Entrants wear a body harness when feasible. An attendant is mandatory. Entrants and attendants have 2 way communication during when the space is entered. Entrant and attendants have a gas meter that is used before entry into the space.

  • External Rescue: The space cannot be entered unless the local responding agency has been notified and on call. The responding agency must be versed in confined space rescue. Must have been onsite to review the location's spaces or have a drawing showing the location of the spaces.

  • If our employees enter the Permit Required Confined Spaces, do they fill out the requiredPermit Required Confined Space "PERMIT" Does the location use the Kimball International standardized (recommended) permit?

  • Are the permits posted at the location of the space entry and is the Job Safety Procedure attached and reviewed prior to entry?

  • Has the gas meter been fully calibrated within the last 6 month period? Is the gas meter calibrated prior to each use? Is the person using the gas meter well trained in its use? And the meter is used during the entry work to assure that the conditions remain safe?

  • Has the training been provided in the past 12 months for those that work with the confined spaces?


  • Anyone issued a lock is considered an authorized employee and must be appropriately trained.<br>* training must occur at least annually, attendance confirmation required<br>* the lockout training must be specific to the equipment that the employee is locking out<br>* training must include multiple lockout (group) situations

  • Locks must be utilized when performing lockout/tagout when applicable. Tags are used for identifying who is performing the lockout. Tags alone cannot be a for of lockout.

  • Locks must be uniform and unique for lockout. Your specific lockout plan should identify what type of locks you are using (back page addendum).

  • Locks must be individualized for each employee with only 1 backup key that is controlled by the safety manager. Locks and keys cannot be shared.

  • An employee may have multiple keyed alike locks but this is only applicable to the one employee.

  • Community (groups using the same locks and keys) lockout is not permitted.

  • The lockout principle can be utilized on electrical cords provided the cord is unplugged and the employee has exclusive control of the plug.

  • When performing lockout, the employee must verify that the energy source is no longer present before starting the required work.

  • Shift changes requires ongoing employee to use their lock before removing the outgoing employee's lock.

  • If lockout is left after the work shift and the employee does not return the next shift, we must attempt to contact the employee before the lock is removed.

  • Removal of any guard(s) requires lockout prior to removal.

  • Cleanup of equipment where the unexpected startup of the equipment could result in an injury, requires lockout.

  • Key switches, push-buttons, selector switches, safety interlocks and other control circuit type devices are NOT energy isolating devices. <br>* minor servicing exception to the lockout/tagout standard. Activities such as lubrication, cleaning, un-jamming, servicing of machines or equipment, and making adjustments or tool changes are covered by the standard, if employees may be exposed to hazardous energy. However, some activities properly are classified as "servicing and/or maintenance" activities, but they are minor in nature and performed during normal production operations. Operations such as lubricating, draining sumps, servicing filters, making simple adjustments, and inspecting for leaks and/or malfunction are examples of routine servicing and maintenance activities, which often can be accomplished safely with effective production-mode safeguards, such as machine guarding methods. These servicing tasks do not require extensive disassembly of the machinery/equipment. Minor tool changes and adjustments, and other minor servicing operations, which take place during normal production operations, are not covered by this standard if they are routine, repetitive, and integral to the use of machines or equipment for production, and if work is performed using alternative protective measures which provide effective employee protection such as noted by the following:<br>Not considered minor "if"<br>1. Remove or bypass machine guards or other safety devices;<br>2. Place any part of their bodies in or near a machine's point of operation; or<br>3. Place any part of their bodies in a danger zone associated with machine operations.<br>Lockout is not required when each of these elements exists (ie...guarding in place, not exposing body part near the point of operation or in its danger zone) and employees may perform servicing maintenance activities with the machine or equipment energized. However, activities requiring machine or equipment shutoff and disassembly, such as changing a machine tool or cutting blade require physical locking out of the equipment or machine.

  • Lockout procedures must be well documented on the Job Safety Procedures must be readily available and easily accessible for reference by the employees required to perform the lockout.

  • Group lockout should have a 'designated' leader,which could change if multiple shifts or crews were required<br>* Multiple employees on an operation must have their locks on a hasp lockout, only 5 locks can be on a 6 hole hasp, the 6th hole is for another hasp to be applied.

  • Operators must be audited annually to assure they know how to properly lockout their equipment.<br>* audits must be formally documented and signed by the person being audited and the auditor<br>* lockout auditors must be qualified to perform the audits<br>* audits of similar operations (grouped liked machines) may focus on one machine per year (ie...8 boring machines, can audit one machine per year

Machine Guarding (Level 1)

  • Are machines guarded appropriately, including mill machines and metal lathes?

  • Are machine operators properly trained to operate equipment that includes indexible tooling (if applicable)?

  • New Job Hazard Analysis have been performed on machines that have potential for 'free handing' or where hands may be in close proximately of the work being performed? A partial listing includes; metal lathes, mill machines, shapers, pin routers, multi head boring machines, bandsaws, belt sanders, table saws, mitre saws.

  • Do we ensure that gloves are not worn by operators while operating machines or equipment which have rotating spindles or components that the operator can come into contact with.

  • Do all automated sensors work (none blocked or inoperable) and are these sensors on a regular schedule to be checked by someone other than the operator (who should be checking on a regular basis as well)?

  • Is proper guarding in place for operations such as wood grinders, compactors and wood storage bin augers?

  • Is there an approval process for new tooling or heads (specifically for working operators that have high speed cutting heads)?

  • Are saws used for ripping equipped with anti-kick back devices and spreaders?

Electrical (Level 1)

  • Only those trained properly perform electrical related work (training must have been verified, once every two years at a minimum)

  • Buss ducts or other similar devices may never be worked on when 'live'.

  • There are no exposures to high voltage equipment.

  • There are no access points inside electrical breaker boxes (ie...missing blanks, etc).

  • If used, are personal equipment such as a fan, approved and tagged prior to use and personal heaters are not permitted.

  • Are switches, receptacles, etc., provided with tight-fitting covers or plates.


  • Inventory: Flammable Liquids are kept to a 1 day supply in production areas.

  • Smoking is not permitted within the building or no signs of smoking is noted.

  • Are wood working finishing stacks properly cleaned, not showing signs of excessive build up, and on a regular schedule to be cleaned.

  • Are all lighting fixtures, and or spark producing devices, within 20' of spraying areas Vapor Proof or Explosion Proof or 5' of spraying areas with interlocking booths.

  • Are combustible scrap, debris, and waste materials (oily rags, etc.) stored in covered metal receptacles and removed from the worksite at the end of every shift.

  • Is storage of foam kept to minimum levels within the building, and stored 5' or below hen stored inside the building.

  • If removing filters from spray operations, are the filters that could react with each other properly segregated for removal and storage for disposal.

  • Are 'purge timers' set properly in gas fired ovens (typically in wood finishing operations) and monitored on a regular audit or preventive maintenance schedule.


  • FM Global Hot Work Permit Program is in operation. A written policy is in use.

  • Written Hot Work Permit program identifies by specific name the persons who manages the hot work program.

  • Business Unit Manager has viewed the FM Global Hot Work Permit Program training (video or online).

  • Business Unit Manager has signed the written Hot Work Permit Policy statement and plan.

  • Hot Work Permits are completed correctly.

  • We provide the 'fire watch person' for all hot work operations.

  • All maintenance persons who work with areas of hot work have been trained in Hot Work Permit program requirements.

  • The facility uses the FM RED TAG impairment system for when the fire suppression system is 'impaired'.


  • There is a comprehensive Fall Protection Program in place that protects employees when exposed to heights of 4 feet or meter, such at all leading roof edges, roof openings, working on top of spray booths, ovens, storage areas, while working in aerial lifts, etc?

  • All Fall protection equipment, such as harnesses, are in good working order and within their typical shelf life (ie....5 years or less).

  • Have operators required to operate AERIAL LIFTS been given proper training.


  • Combustible dust is managed and maintained under 1/16" or 1.5mm in all areas of the facility which includes overhead building members and specific operations such as wood grinding operations, wood working equipment, dust bins, etc.

  • Combustible Dust Permits are utilized for all area cleanings. Includes both internal and external resources who perform the cleaning.

  • Compressed air is not used to clean overhead building members or structures.

  • Only non-sparking type vacuuming systems are utilized to vacuum combustible dust.

  • Combustible dust levels are monitored in a systematic process such as area audits or preventive maintenance schedules.

  • Operations or areas that have higher exposure to constant dust must be Class II Division II electrical service.

  • Training has been giving to those that perform dust removal (whether internal or external resources are utilized).


Aisles / Passageways

  • Are aisles and passageways appropriately marked, kept clear and in good repairs, with no obstruction across or in aisles that could create a hazard?

Exit Routes / Exit Marking

  • Are exits marked by a readily visible sign that is illuminated?

  • Is every door, passage, or stairway that could be mistaken for an exit or a way of exit access, identified by a sign reading "Not an Exit"or similar designation, or identified by a sign indicating its actual character, such as "To Basement," "Storeroom," or "Linen Closet"?

Alarms / Warnings—General Requirements

  • Does your plan include a way to alert employees, including disabled workers, to evacuate or take other action, and how to report emergencies?

  • Does the alarm system provide separate distinctive alarms sound for evacuation (continuous) vs. seek shelter (pulsating) sounds and are employees familiar with the alarms and know which action to take?

  • Can alarms be heard, seen, or otherwise perceived by everyone in the workplace?

  • Do you provide an auxiliary power supply if electricity is shut off?

  • Have you established procedures for sounding emergency alarms in the workplace?

Tobacco Use Guidelines

  • Business unit has created a tobacco policy with rules and regulations and posted such information in appropriate areas.

  • The use of tobacco products on company property is restricted to personal vehicles parked a minimum of 25 ft. from the building doorways. Tobacco use areas have been identified and isolated from risk to property.

  • Consideration to customers needs when visiting our locations should be provided, however, not at the risk of our assets and should be consistent with the Tobacco Policy Guidelines.

  • There will be NO SMOKING within 75 feet of any flammable materials stored on the property and appropriate signage must be in place.

  • Any designated tobacco use area that is not kept orderly and clean is subject to be eliminated. Our customers may be sharing this area as well.

  • The Tobacco Policy must be communicated to all personnel prior to working on site, including employees, suppliers, customers, contract labor, etc. Appropriate signage must be in place to ensure employee and visitor awareness.

  • Designated areas for the use of tobacco must be located away from the main entrance to the facility and meet the specifications of the other guidelines provided.

Fire Extinguishers

  • Are portable fire extinguishers provided, mounted, located, and identified so that they are readily accessible to employees?

  • Are only approved portable fire extinguishers used?

  • Are all portable fire extinguishers in the workplace inspected, maintained, and tested?

  • Is an annual maintenance check performed on portable fire extinguishers?

  • Is alternate equipment protection provide when fire extinguishers are removed from service for maintenance and recharging?


  • Does every stairway having 4 or more treads have a hand rail?

  • Where stairs or stairways are present in any area where vehicles may be operated, are adequate barriers and warnings provided to prevent employees from stepping into the path of traffic?

Emergency Response / First-Aid / AED Program

  • If you have an automated external defibrillator, is it maintained per manufacturer's instructions? Turn on the AED, assure that it powers up. Assure that the batteries and pads are current.

  • Is the AED marked to show its location?

  • Is the AED audited with a documented procedure that includes noting the expiration dates for the pads and batteries?

  • Are first-aid supplies readily available?

  • Assure medications are not provided by the company, but can be dispensed using vending machines to provide employees to purchase and access. This removes liability from the business unit.

Blood borne Pathogens

  • Do all employees who are expected to respond to medical emergencies as part of their work have available and understand how to use appropriate personal protective equipment to protect against exposure to blood borne pathogens.

  • Is a container provided for reusable sharps that is puncture resistant, properly labeled, and leak proof.

  • If applicable, have you established and do you maintain a sharps injury log for recording of injuries from contaminated sharps.

  • Where employees have had an exposure incident involving blood borne pathogens, was an immediate post exposure medical assessment and follow up provided.

  • Do you establish and maintain an accurate record for each employee with occupational exposure to blood borne pathogens.

  • Do you maintain all employee medical records for at least the duration of employment plus 30 years.

Electrical (non Level 1 items)

  • All electrical panels have 36"clearance.

  • extension cords are not permitted for permanent use and only GFII extension cords are utilized by maintenance.

  • Are portable electrical tools and equipment and fixed electrical equipment grounded or of the double insulated tape.

  • If used, are personal equipment such as a fan, approved and tagged prior to use and personal heaters are not permitted.

  • Are switches, receptacles, etc., provided with tight-fitting covers or plates.


  • Does facility have a written ergonomic plan.

  • Are workers movements analyzed so that potential injuries are avoided.

  • Is work flow properly organized.

  • Are cushioned floor mats provided for workers who are required to stand for long periods.

  • Are mechanical aids and equipment provided where feasible.

  • Are worker movements analyzed so that potential injuries ( e.g., hand or foot injuries, repetitive motion injuries, or strain from lifting) are avoided.

  • Have you prevented employees' hands or arms from being subjected to pressure from sharp edges on work surfaces.

  • Is the work surface height proper and adjustable.

  • Is the workstation designed to minimize or eliminate twisting at the waist, reaching above the shoulder, bending at the waist, static muscle loading, extension of the arms, bending or twisting of the wrist, and elevation of elbows.

  • Where chairs or stools are provided are they easily adjustable and suited to the task.

  • Have all employees been provided basic information bout how to report MSDs and their signs and symptoms in your workplace.

Flammable/Liquid Fire Safety

  • Are you using flammable Liquid Containers?

  • Does Flammable Liquid Containers have a pressure relief valve?

  • Does Flammable Liquid Containers have a spring loaded closure device?

  • Do all safety containers for flammable liquids contain a wire mesh baffle in the pouring spout to provide a flame arrestor?

  • Are Flammable Liquids stored in an approved flammable storage cabinet when not in use which is grounded?

  • Do all flammable liquid containers have proper HMIS labeling?

Flammable/Combustible: Containers

  • Are all flammable liquids kept in closed containers when not in use (e.g., parts cleaning tanks, pans,etc.)?

  • Are bulk drums of flammable liquids grounded and bonded to containers during dispensing?

  • Are storage cabinets used to hold flammable liquids labeled "Flammable--Keep Fire Away"?

  • Are storage tanks adequately vented to prevent the development of excessive vacuum or pressure as a result of filling, emptying, or atmosphere temperature changes?

Flammable/Combustible: Handling

  • Are ground connectors clamps in good condition and appropriate for establishing a ground?

  • Are all pumping pressure tanks grounded properly?

  • Are "No Smoking" rules enforced in areas involving storage and use of hazardous materials?

  • Are materials that are combustible stacked at proper heights (polystyrene < 6', cardboard < 13', skids < 6') Factory Mutual regulation?

  • Are wooden pallets stored away from the outside of the building?

  • Is proper storage of flammable or combustible materials practiced to minimize the risk of fire including spontaneous combustion?

  • Is there one clear aisle at least 3 feet wide?

Spray Painting

  • Is spray gun interlocked with exhaust system so no spraying without exhaust?

  • Are "No Smoking" signs posted in spray areas, paint rooms, paint booths, and paint storage areas? Signage to prohibit Cell Phones & Pagers Postage in flammable areas.

  • Are spray booth stacks clean and kept on an adequate cleaning schedule?

  • Do ducts have access doors to allow cleaning?

  • Is in use, is infrared drying apparatus kept out of the spray area during spraying operations?

  • Is the spray area at least 20 feet from flames, sparks, operating electrical motors, and other ignition sources?

  • Is the spray area free of hot surfaces?

  • Is the spray area kept clean of combustible residue?

  • Are all tools used for cleaning purposes made of non-sparking material?

Respirator Program

  • Do you conduct assessments of the workplace to ensure that the written respiratory protection program is being properly implemented, and consult employees to ensure that they are using respirators properly?

  • Do you have a written respiratory protection program with required worksite-specific procedures and elements for required respirator use?

  • Do you provide effective training to employees who are required to use respirators?

  • Do you conduct fit testing?

  • Are all respirators used in routine situations inspected before each use, and during cleaning?

  • Are all respirators stored so that they are protected from damage, contamination, dust, sunlight, extreme temperatures, excessive moisture, and damaging chemicals?

  • Does the program include medical assessments of employees required to use respirators?

  • Do you establish and retain written information regarding medical assessments, fit testing, and the respirator program?

Forklift Operations / Daily Inspection

  • Are only trained and certified persons allowed to operate forklift trucks? Are certification cards issued with latest training date?

  • Forklift truck is equipped with seat belt protection that the operator uses while operating lift.

  • Are your forklifts pre-inspected daily before being placed in service and all items on the checklist in good working order (forks, tires, hoses, etc). Forklifts that leak must be taken out of service immediately until repaired. No signs of oil or hydraulic fluid drips on the floor.

  • Do all forklifts have a mounted fire extinguisher?

  • All operators wear hard hats while operating the lift.

  • Does each industrial truck have a warning horn, whistle, gong, or other device that can be clearly heard above the normal noise in the areas where operated?

Battery Charging

  • Are battery charging installations located in areas designated for that purpose?

  • Are batteries charged in a properly vented room?

  • Are tools and other metallic objects kept away from the top of uncovered batteries?

  • Is eyewash flushing station available in battery charging area?

  • Is a conveyor, overhead hoist, or equivalent material handling equipment provided for handling batteries?

  • When charging batteries do you make certain not to pour water into acid?

  • Are trucks properly positioned and brake applied before charging or charging batteries?

Hazard Communication / Labeling

  • Do you ensure that each container of hazardous chemicals is labeled, tagged, or marked with the appropriate hazard warnings?

  • If you remove or deface labels on incoming containers of hazardous chemicals, do you immediately mark the containers with the required information?

  • Do you ensure that labels or other forms of warning are legible and prominently displayed on the container, or readily available in the work area throughout each work shift?

Hazard Communication / Material Safety Data Sheets (MSDS)

  • Do you have a material safety data sheet for each hazardous material that you use?

  • Are MSDS's available to all employees at all times?

  • Are MSDS's properly stored and maintained for 30 years post the final usage of the products? Verify storage and retention.

Hazard / Workplace

  • Only Safety type utility knives are used. Single edged blades are not used outside of an approved holder or device.

  • Is there a program or process in place to assure that heating irons/inspection lights are properly stored and heat eliminated during non usage?

Personal Protective Equipment (PPE)

  • Personal protective equipment (PPE) provided and are all employees required to use PPE as needed to protect against injury?

  • Is protective clothing and equipment provided and used when cleaning up spilled toxic or otherwise hazardous materials or liquids?

  • Are employees who need corrective lens (glasses or contacts) in working environments having harmful exposures required to wear only approved safety glasses, protective goggles, or use other medically approved precautionary procedures?

  • Are protective goggles or face shields provided and worn where there is any danger of flying particles or corrosive materials?

  • Is appropriate fall protection provided?

  • Is appropriate foot protection required where there is the risk of foot injuries?w

  • Is appropriate hand protection required where there is risk of hand injury?

Hearing Conservation

  • Do workplace noise levels conform to government standards? Verify sound level readings.

  • Are workers protected from sources of excessive noise?

Housekeeping / General

  • Are all spilled materials or liquids cleaned up immediately?

  • Is proper housekeeping maintained?

  • Are work surfaces kept dry or are appropriate means taken to assume the surfaces are slip-resistant?

  • Is the compressed air for cleaning under 30 psi?

Harmful Dust

  • Are dust and chemicals kept from being dispersed into the air.

  • When effective engineering controls are not feasible, are workers using appropriate respirators to protect them from harmful dusts, fogs, fumes, mists, gases, etc.?

  • Is dust accumulation kept from developing 1/8" or more build up on pipes and building?

  • Does the facility provide vacuuming process to remove dust buildup?

  • Is dust collection system adequate to remove excessive dust accumulation?

Materials Handling

  • Are overhead lifts inspected annually to ensure that it can lift what it was designed to?

  • Are containers stored, stacked, blocked, and limited in height so they are stable and secure?

  • Are dock boards (bridge plates) used when loading or unloading operations are taking place between vehicles and docks.

  • Are trucks and trailers secured from movement during loading and unloading operations?


  • Are all step ladders is use, under 20' in length?

  • Are all ladders fiberglass due to 1. Electrical non conductivity. 2. Weight of ladder. 3. Ability to maintain tight joints on ladder ( Note: Wood ladders can accumulate dirt and oil and thus provide conductivity of electricity).

  • Are ladders free from sharp edges and splinters?

  • Are only ladders with safety feet used?

Storage Racks

  • Do storage racks provide maximum weight limit warnings?

  • Do storage racks provide proper flue spacing for water dispersion in case of fire?

  • Do all shelves have safety clips or other features to prevent the shelves from being pulled apart during loading or unloading by forklifts?

  • Has any damage members of storage racks been repaired or replaced?

  • Are storage racks fastened to floor or wall to prevent tipping?

  • There is 36" clearance below all sprinkler racks?

  • Are pallets stored at a limited height to maintain stability and security?

  • Are pallets stored at least 10' or 3 meters from the outside of the building?


  • Are only approved apparatus ( torches, regulators, pressure-reducing valves, acetylene generators, manifolds) used?

  • Are only authorized and trained personnel permitted to use welding, cutting, or brazing equipment?

  • Does each operator have a copy of the appropriate operating instructions for welding and are they directed to follow them?

  • Is a check made for adequate ventilation in and where welding or cutting is performed?

  • Is grounding of the machine frame and safety ground connections of portable machines checked periodically?

  • Is red used to identify acetylene (and other fuel-gas) hose, green for oxygen hose, and black for inert gas and air hose?

  • Is necessary personal protective equipment available?

  • Are compressed gas cylinders kept away from sources of heat?

  • Are fire watchers assigned when welding or cutting is performed in locations where a serious fire might develop?

  • Are signs reading "DANGER NO SMOKING, MATCHES, OR OPEN LIGHTS" or the equivalent, posted in welding areas?

  • If welding gases are stored, are oxygen and acetylene separated by a 5-foot no combustible barrier?

  • Is fire extinguishing equipment that is available in work areas where welding, cutting, or heating is being performed maintained in a state of readiness for instant use?

Compressed Gas Cylinders

  • Are all valve protectors always placed on cylinders when th cylinders are not in use or connected for use?

  • Are cylinders legibly marked to clearly identify the gas contained?

  • Are cylinders located or stored in a manner to prevent them from creating a hazard by tipping, falling, or rolling?

  • Are valves closed off before a cylinder is moved, when the cylinder is empty, and at the completion of each job?

  • Do the high pressure compressed gas cylinders have the correct pressure relief valves (I.e....with relief holes)?

General Guarding

  • Are all pulleys, fan blades and belts that are within 7 ft of the floor or working level properly guarded?

  • Are foot-operated switches guarded or arranged to prevent accidental actuation by personnel or falling objects?

  • Are radial arm saws so arranged that the cutting head will gently return to the back of the table when released?

  • Do bench grinders have proper spacing for guards bottom (1/4") and top (1/8")?

Facility Security

Perimeter Security

  • All areas of the parking lot are well lit at night and lights are well maintained.

  • All outside gates are secured.

  • All entrance doors close and lock properly.

  • Access to roof is deterred adequately.

Alarm Security

  • Appropriate doors have door alarms.

Access Control

  • There is a formally defined and followed master key control plan.

  • All access doors are locked during operational and non operational times, including dock doors secured.

  • Access into the facility is controlled by access cards or hard keys.

  • Exit doors that have electronic access control use 'fail safe' technology.

  • All employees wear their access cards.

  • There is no indication of 'tailgating'.

  • The main entrance or lobby is well secured.

Workplace Violence

  • An actual drill has been performed within the past 12 months (documented results)?

  • There is a formal key return program for terminated employees.

  • An initial or refresher training has been given in the past 12 months ( documented).

  • Advanced training has been given to select groups (lobby attendants, L.E.R.T. Crisis teams or other groups.

  • 'What if Scenarios' have been created specifically for this facility.

  • There is a 'specific' alarm or alerting message designated.

  • There are strong accountability measures regarding workplace violence or harassment.

  • The local police have been on site in the past 36 months to become familiar with the facility.


  • The front or main entrance has an 'attendant' or is monitored though security cameras.

  • There is an after hours watchman on duty or security cameras are used to monitor activities.


  • All new hires have received both the locations general awareness Security and Workplace Violence training.

  • All tenured employees have received both the general awareness Security and Workplace Violence training during the past 12 month period.

  • Randomly selected employees know their roles in the event of a Security drill or event.

Management Commtent

  • There is a documented 'Security Program' in place.

  • The Security plan has been reviewed and updated during the past 12 month period.

  • An initial Risk Assessment has been performed.

  • A new risk assessment as been performed at 5 year intervals.

  • Internal annual assessments are being performed to sustain program and seek ontinus improvement.

  • Security s incorporated into the Local Emergency Response Team (LERT) and emergency response s reviewed at each LERT meeting.

  • All security related incidents are properly documented and investigated.

Visitors Program

  • All visitors enter through the front or main doors.

  • All visitors wear proper I.D.

  • All external visitors sign in and out.

  • All contractors, vendors, and service groups are properly identified.

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.